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First IAP Focus Area: Reducing Substance Use Disorders

We are excited to confirm that the first IAP focus area will address strategies to improve states substance use disorder (SUD) treatment systems.  SUD is a serious and growing problem in the U.S., but evidence is also strong for the efficacy and cost-effectiveness of treatment. Based on conversations we’ve been having for the past couple of years about the importance of expanding and improving services for SUD, we think the timing is right to collaborate on the introduction of some significant system reforms.

First, it’s an area of need. Nearly 12% of Medicaid beneficiaries over 18 have an SUD, and people on Medicaid are at six times the risk of prescription drug overdose compared to non-Medicaid patients. In fact, drug overdose death rates in the U.S. have more than tripled since 1990, and are now the leading cause of injury death, causing more deaths than car crashes among adults 25-64 years old. Resources are also needed to address the high rates of SUD among adolescents. The costs are high — in 2009, health insurance payers spent $24 billion for treating SUDs, of which Medicaid accounted for 21%.

Second, we can build systems that do better. One large health plan found that total healthcare costs, including inpatient, emergency department (ED), outpatient, ambulatory and pharmacy costs, were 30% less for alcohol-dependent individuals receiving medication-assisted treatment (MAT) than for alcohol-dependent individuals not receiving MAT.  Evidence is also accumulating about the cost-effectiveness of many other strategies for screening and treatment of SUD. This area of focus is especially timely given the increases in coverage for behavioral health services under the Affordable Care Act, including Medicaid and CHIP. 

Finally, we have heard you—in surveys, in conversations, in meetings – that this needs to be a priority for CMS.  IAP is not meant to introduce new work for states, it’s about supporting work that states already have underway or want to do. SUD has been coming up in almost every discussion we have. 

We invite states to leverage IAP tools and technical assistance to introduce system reforms that better identify individuals with a SUD, expand coverage for effective SUD treatment, and enhance SUD practices delivered to beneficiaries. The first structured technical assistance opportunity that we are making available through the IAP is a “learning collaborative” designed to facilitate the spread of successful strategies for mitigating SUD. In the weeks to come, CMS will release guidance and hold a webinar for states interested in learning about additional SUD-related technical assistance opportunities.  

For this first learning collaborative for the IAP, we’re looking for states that are interested in investing in transformative changes in their SUD treatment systems in raising the bar for SUD service design and delivery. If your state is interested in joining this SUD Learning Collaborative, or if you have ideas about SUD-related challenges, strategies, data needs, or other considerations for us to think about, please let us know at MedicaidIAP@cms.hhs.gov.

IAP Commentary
John O'Brien, Senior Policy Advisor, CMCS and David Shillcutt, Disabled and Elderly Health Programs Group


Collections: IAP Commentary