Innovative programming to address substance and opioid use disorders
Carelon Behavioral Health senior leaders discuss innovative programs to combat substance and opioid use disorders
The Carelon Behavioral Health team consists of: James Polo, MD, Chief Medical Officer; Sandrine Picard, MD, West Region Chief Medical Officer; Dheeraj Raina, MD, Medical Director; and Shawna Zabkiewicz, Chief of Staff, Behavioral Health Services. Brad Lerner, Director, Public Policy, Elevance Health, moderated the discussion.
[Brad Lerner] With more than 40 million Americans twelve years of age and older experiencing a substance use disorder (SUD), we pulled together an impressive team of experts to talk about programs in this space that are making a difference in people’s lives.
It’s vitally important to have this dialogue, as SUDs are diseases that impact whole health, and range in severity from mild to severe. SUDs affect people of all races, genders, income levels, and social classes, and can result in significant issues — including relationships at home, and performance in school or on the job..
It’s also important to recognize that many people with SUDs may have other medical issues, including mental health conditions, that should be factored into their treatment options. But recovery is possible, and our experts discuss several proven and effective programs that really work.
Dr. Polo, as the Chief Medical Officer for Carelon Behavioral Health, what is it about substance use disorder that has you most concerned?
[Dr. James Polo] According to the Centers for Disease Control and Prevention, one in seven Americans aged twelve or older reported experiencing an SUD. SUD diagnoses can include alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, stimulants — even tobacco.2 Because of the scale of this issue, SUD treatment is a key priority for Carelon Behavioral Health. I also have firsthand, personal experience with this issue and know how devastating it can be.
We know that the use of technologies, innovative clinical models, and predictive data analytics can and do make an impact and improve SUD and opioid use disorder (OUD) outcomes. For example, scalable use of telehealth can expand access to care and mitigate barriers related to stigma, geography, and cost. During the COVID-19 pandemic, the Drug Enforcement Agency allowed for expanded use of telehealth for treating SUDs. The data showed that telehealth reduces overdose rates and helps people stay on track with their recovery. Telehealth makes it easier for doctors to check in with their patients to encourage their progress and allows peer recovery specialists to provide support and resources when needed.
[BL] I’m glad you brought up peer support, Dr. Polo, as this is evolving as an important part of successful SUD treatment programs. Not only can peer support specialists share relatable experiences with those experiencing SUDs, but they also help bridge gaps in care when people experiencing addiction aren’t able to see a therapist quickly or are suffering from stigma to seek out more aggressive treatment. Shawna, your Empower program relies on peer support specialists. What can you tell us?
[Shawna Zabkiewicz] We launched the Empower program in 2023. It engages women between the ages of 18 and 40, when women may become pregnant. The program is a combination of resources, information, and peer support to help women of reproductive age take action to reduce risks and make healthy lifestyle choices before, during, and after pregnancy.
Our peer support specialists engage with Medicaid members during an initial phone call, and share their own personal experiences with SUD, which helps to break down barriers and open a dialogue. They can then provide those members with resources, support, and information on SUD and recovery that meets their specific needs.
[BL] Why this program specifically for women of reproductive age?
[Shawna Zabkiewicz] We know that SUDs among this population have contributed to increasing rates of neonatal abstinence syndrome and neonatal opioid withdrawal syndrome. In fact, 22 thousand babies are born with NAS each year — that’s one every 24 minutes.
If a member elects to participate, the peer specialist can connect the member to physical and behavioral healthcare providers, recovery specialists, and health plan case managers. The peer specialist can even help schedule appointments. There’s an app for additional 24/7 access to peer recovery support.
By identifying and helping these women through non-clinical and digital support to facilitate their wellness, recovery, and reproductive health, we can not only help improve the lives of these current and future mothers, but also prevent newborn exposure to substances in the womb.
[BL] In my government affairs role, I spend a lot of time with national and state officials who want to know why progress in combating the opioid epidemic has been so slow. I’d like to talk now about some population health-based approaches to enhance not only access to treatment for opioid use disorder, but also the quality of care delivered. We happen to have two addictionologists on our team in Dr. Raina and Dr. Picard. Dr. Raina, would you please tell us about the RISE program?
[Dr. Deeraj Raina] The Resilience Through Information, Support, and Education (or RISE) program employs predictive modeling to proactively identify and support individuals at risk of opioid-related negative health outcomes.
We’ve developed an algorithm that identifies and stratifies members at risk of opioid and alcohol related negative health outcomes in the next 12 months. We then approach the member and, if they agree to proceed, we provide intervention options including case management, peer support (like what Shawna described previously), and a single point of contact for them going forward. The case managers and peer specialists deliver remote and in-person support, care coordination, and coaching to address physical and mental health.
Our clinical outcomes have been very positive. Based on internal 2024 data, participants have recorded a significant improvement when compared to a control group.
- 63.1% reduced inpatient admissions
- 54.6% reduced Emergency Department visits
- 39.5% reduction in overdoses of any kind
- 27.5% reduction in inpatient admissions with SUD Dx
- 9.2% reduction in Emergency Department visits with SUD Dx
[BL] Dr. Picard, what about medications for opioid use disorder (MOUD) in inpatient settings?
[Dr. Sandrine Picard] The typical treatment pathway without medication involves an increased risk in patients leaving a treatment facility against medical advice, having a relapse or repeating detox, or even overdose or death. Even when medication for OUD is referred, we know that there’s an increased risk for failure to initiate and the potential for engagement in treatment with mixed outcomes.
That’s where our Changing Pathways program comes in. It leverages evidence-based practice to promote the use of MOUD induction — rather than the traditional medical taper method — for inpatient withdrawal care management, and provides care coordination and peer support to enhance treatment outcomes.
We include frequent and thorough education of individuals with an OUD on MOUD to help them better understand how it can support them in their recovery and offer them the option to be initiated on MOUD during their inpatient stay (instead of traditional taper).
The program also provides MOUD patients with comprehensive discharge and warm handoffs to continued resources and care. Based on internal 2024 data, Changing Pathways delivers several positive outcomes for our members with OUD, including:
- Reduced admissions within 7 days and at 30 days.
- 2.5 times higher adherence rate to MOUD.
- 74% reduction in overdose for those who remained MOUD adherent for 90 days following discharge.
[BL] While opioids are particularly devastating, alcohol remains a significant issue in this country as well.
[Dr. Deeraj Raina] Approximately 140,000 deaths occur yearly due to alcoholism, and there are nine organ systems where alcohol use contributes to cancer. Approximately 7% of all Emergency Department visits are alcohol related, and because many do not seek behavioral health and SUD treatment, it rarely triggers our case management identification.
Last year, we launched Connections, which is an intervention essentially designed to help members across our commercial, Medicare, and Medicaid health plans who are typically overlooked. The goal is to increase the likelihood that the members engage in behavioral health case management and alcohol use disorder (AUD) treatment. We look at diagnoses of alcohol dependence, intoxication, and withdrawal; and all physical health diagnoses with the words “alcohol” or “alcoholic” in the descriptor. These include alcoholic pancreatitis, alcoholic liver disease, or esophageal varices.
We still have work to do to, but even limited interaction with these individuals increases the odds that they may eventually begin SUD treatment or start attending a self-help recovery support group.
[BL] Because these issues are so vast, it’s important that we enlist government and community support as well to affect meaningful change.
In the community space, we have a significant corporate foundation commitment to support some remarkable local programs. Here are just a couple of examples:
[Dr. Polo] Our Elevance Health parent company foundation has granted more than $5 million to Shatterproof. The organization helps to improve SUD treatment by reducing beliefs held by healthcare professionals about the stigma of addiction, with an emphasis on socially vulnerable populations. Shatterproof also supports nationwide access to evidence-based prevention, treatment, and recovery.
[Dr. Picard] For people who are newly sober or recently released from treatment or incarceration, access to stable, sober housing is critical to maintaining recovery. A new grant to the Chris Atwood Foundation will allow more individuals to seamlessly transition from treatment for substance abuse to a safe and supportive housing environment.
