January 19, 2018 |
Blog: The Recovery Coach Challenge
Tim Comeaux | Behavioral Health Services Director at Manet Community Health Center
& RRI Staff
As recovery coaches gain popularity across the country, health centers to hospitals scramble to find ways to fund them.
Massachusetts has been a national leader in addressing the opioid epidemic. Landmark legislation has helped to fund recovery support services across the state. Within these statewide efforts, a push has been made to fund recovery coaches, typically non-clinical peer mentors with lived experience of active addiction and successful recovery, that assist patients in setting and achieving recovery oriented goals. Much of this funding has been designated to come through the MA Department of Public Health, Bureau of Substance Abuse Services (BSAS), as grants, outpatient counseling contracts, or pilot reimbursement programs.
Specific grants and programs that have funded Recovery Coach positions include:
- The Opioid Triage Center Grant: opened the SSTAR Triage Center which includes Recovery Coach funding to improve the continuum of treatment and care. The two other programs funded in the pilot were Boston Medical Center and Community Health Link.
- The Access to Recovery Grant: funding recovery support services, including recovery coach funding and training
Funding for Recovery Coaches has also been done through private institutions or philanthropy, such as the Massachusetts General Hospital Substance Use Disorders Initiative. The hospital dedicated 3.5 million dollars over three years, hiring 7 Recovery Coach positions throughout the hospital.
The goal for sustainability however, is to have Recovery Coach positions pay for themselves after these more temporary funding sources end.
In a new plan recently proposed by Governor Charlie Baker, additional state funding through Medicaid would establish two commissioning bodies dedicated to identifying mandatory qualifications and a standardized credentialing system for the Recovery Coaches. It is in hopes that increasing the standardization of the position will increase leverage on insurance companies to begin reimbursing health centers and hospitals for these peer-support services. Grant funding is only a short-term solution, and largely unsustainable overtime.
Preliminary research has pointed to the effectiveness of recovery coaches as both an aid to recovery and as a method to reduce overall healthcare costs. Recovery Coaches can reduce overall healthcare costs by helping patients better utilize primary care services, get connected to community resources, and help patients make and keep medical appointments. Recovery coaches have the potential to reduce costly, avoidable emergency department visits and hospital readmission within 30 days of being discharged from a hospital.
Despite their potential to increase rates of sustainable recovery and lower overall healthcare costs, the actual financing of these positions remains a central barrier to their widespread implementation and integration into mainstream healthcare. While an increasing number of resources have been dedicated to acute care services for substance use disorder, there has not been the same level of investment in efforts aimed at connecting substance use disorder patients to long-term, continuing care services in their communities.
At some point, there will need to be insurance company involvement and utilization of all available third-party reimbursement options.
Answering the question of how to get reimbursed from the multiple different payers will be central to the pace of expansion of recovery coaches, not just in Massachusetts, but nationally. Calls for Recovery Coach funding are made amidst a large and ongoing struggle within the behavioral health field generally to maintain financial sustainability. This is due to low reimbursement rates for counseling and psychiatry services. Many organizations simply cannot afford their own behavioral counseling services, let alone a Recovery Coach position, without support from grant funding or third party reimbursement (e.g. insurance).
It also still remains to be seen how third party reimbursement will develop in a Medicaid Accountable Care Organization (ACO) environment (ACOs being groups of doctors, hospitals, and other health care providers, who voluntarily join together to give coordinated, high-quality care to the Medicare patients). Some ACOs will likely pay fee-for-service for behavioral health services, while others may choose to pay a capitated per-member, per-month rate.
Resolution on how to pay, and who should ultimately pay for Recovery Coaches will be a long and hard process. Until a standardized formula for payment is developed, Recovery Coach funding will likely be supported by a mix of different situations with multiple different payers. As we look into the future, it is clear the most sustainable funding for Recovery Coaches will be reimbursement by all payers, at fair reimbursement rates.