Opioid use disorder (OUD) is one of the most pressing public health crises in the United States, with more than 75% of the nearly 107,000 drug overdose deaths in 2022 involving an opioid. West Virginia is at the epicenter of this crisis, as the state’s fatal opioid overdose rate was nearly three times the national average in 2020.
A new initiative is saving lives by integrating behavioral and physical health care, an approach that has been widely successful in West Virginia. This initiative, led by Unicare, has reduced the rates of overdose, self-harm and Neonatal Abstinence Syndrome for those with OUD. According to a recent study, this innovative health care strategy has effectively reduced overdoses by 33%, self-harm incidence by 62% and NAS rates by 82% from July 2019 through April 2023 among Medicaid beneficiaries with OUD.
Medicaid managed care plans are uniquely positioned to address the multifaceted needs of people with OUD. As a physician, I have seen firsthand the positive effects from combining behavioral and physical health services. There is an opportunity to support sustainable and consistent delivery of integrated care within West Virginia and across other states, as well as tailor integrated care services to the needs of individuals.
The most effective strategies employ a more holistic and effective approach to treatment and offer a model for other states grappling with similar issues.
One of the most effective initiatives for West Virginia has been leveraging the state’s 1115 demonstration waiver, implemented in 2019. These waivers pilot new approaches to care, such as the Collaborative Care Model (CoCM), which integrates behavioral health case management with primary care and psychiatric consultation. This waiver allows for a continuum of care demonstration aimed at reducing substance use disorders and improving outcomes for those with OUD. States with similar waivers can utilize this waiver to enhance their care strategies, focusing on direct member services, strategic partnerships and innovative approaches to care.
Another strategy is the deployment of behavioral health case managers in residential treatment centers and substance use disorder residential adult services programs. These case managers play a crucial role in bridging the gap between behavioral and physical health care. Including individuals with lived experience in the development of care strategies ensures that the services provided are tailored to the actual needs and preferences of those affected. They not only support members during treatment but also educate care providers on the unique needs of individuals with OUD.
This dual approach ensures that patients receive comprehensive care that addresses both their immediate health concerns and the underlying factors contributing to their substance use.
States also should shift their focus on pregnant women with OUD. By establishing a dedicated physical health team that includes a medical director and a high-risk obstetrics case manager, care plans can make sure pregnant women and their infants receive care for up to six months, post-delivery. This initiative is crucial in preventing NAS and ensuring better health outcomes for both mothers and babies.
Collaboration between states, providers, payers and community-based organizations can enhance technological infrastructure, facilitate shared data and optimize resources to better support integrated care. Moreover, a care plan’s collaboration of digital therapeutics with personalized case management showcases the potential for technology to enhance treatment adherence and recovery support. These digital tools provide tailored support and incentives for individuals managing their substance use recovery, addressing both medical and social determinants of health.
It is crucial to combine behavioral and physical health services for a more cohesive, supportive and effective treatment environment for individuals with OUD. West Virginia’s integrated care model not only improves health outcomes but also offers a more compassionate approach to treating addiction, recognizing the complex relationship between physical health, mental health and social factors.
As the opioid crisis ravages communities across the nation, it is imperative that other states look to West Virginia’s integrated care approach as a blueprint for their own efforts. By adopting similar strategies, states can improve care for people with OUD, reduce fatal overdoses and, ultimately, save lives.
Integrated care is not just a treatment strategy; it is a lifeline for those struggling with opioid use disorder.
Dr. Jorge Cortina is the behavioral health medical director for UniCare Health Plan of West Virginia. He has spent more than 20 years in higher education, public/private sectors, business and consulting.
