Designing Complex Care Management Programs to Support Patients With Substance Use Disorder: An Essential and Overlooked Opportunity.

backgroundIndividuals with substance use disorders (SUDs) have high rates of medical and mental health comorbidities, health care utilization, and costs. Improving the capacity of care management programs to meet the needs of those with SUDs could benefit Medicaid accountable care organizations, but there are few reports of strategies to do so. PROGRAM APPROACH: The Boston Medical Center Health System Complex Care Management (CCM) program aims to build trusting relationships with the highest-risk patients across five Massachusetts Medicaid accountable care organizations and work with those individuals to achieve their health-related goals. Given that more than half of CCM-enrolled patients have been diagnosed with a SUD, CCM has adjusted its staffing models, workforce recruitment and development, patient identification and engagement, approach to health-related social needs, and community partnerships to better meet the needs of patients with an SUD. We have developed strategies to recruit diverse staff; train them on SUDs, harm reduction, motivational interviewing, and trauma-informed care; embed staff members in inpatient and community settings; and ensure teams have access to behavioral health staff for additional support as needed. We have also built partnerships with community, governmental, and health care organizations to ensure patients receive appropriately comprehensive care despite complex social, medical, and behavioral health needs. OUTCOMES: Although most patients with a SUD agree to enroll in CCM when outreached, our data indicate room to improve the rates at which we reach these individuals and sustain engagement. Preliminary pre-post data showed that CCM-enrolled patients had lower rates of overdose and higher rates of engagement with outpatient care for SUDs, mental health, and medications for opioid use disorder.

conclusionOur experience demonstrates that with appropriate training and tools, care management staff perform vital work to improve outcomes for individuals with SUDs, although more detailed research is needed to assess the effectiveness of specific intervention components.