The Washington Post // By Paige Winfield Cunningham // Photo by Jared Soares
Yes, President Trump has declared opioid abuse a national emergency. But a hotel CEO is leading a much more targeted – and more promising – effort to address the country’s rampant addiction problem.
Gary Mendell, the chairman of HEI Hotels & Resorts who lost his son to drug addiction six years ago, has convinced four of the five major U.S. insurers – Aetna, UnitedHealth, Cigna and several of the Blue Cross plans – and a dozen smaller companies to sign onto eight principles of care for patients struggling with addiction.
The hope is that these insurers, which cover a total of nearly 250 million patients, will jumpstart a new era for addiction treatment in the United States by making it easier for patients to access key medications proven effective in helping ease off opioids. The aim is also to direct these patients to the best doctors who use treatments actually backed by science.
The problem right now isn’t so much a lack of treatment – there are more than14,500 drug-abuse treatment facilities in the United States. What’s severely crippling the system is a widespread lack of knowledge about how best to help someone struggling with addiction, according to Mendell. Unlike for other illnesses like cancer or heart disease, where there’s a well-known standard of care, far fewer standards exist for opioid addiction.
“What we all care about is that every American in this country who has a substance use disorder gets treatment based on evidence just like every other disease,” Mendell told me.
Patients too often don’t know where or how to seek help and providers don’t always know which treatments are most effective, Mendell says. Is behavioral therapy enough? Or is medication a better approach? What about a combination of the two?
“You can go to 10 different treatment programs and you will get 10 different approaches,” Mendell said. “No one has any idea who is doing what.”
The problem extends to insurers, which often don’t know which providers are delivering the best care for patients trying to overcome opioid addiction. Mendell said that’s why he’s starting with this corner of the health-care industry, since insurers are instrumental in the kind of treatments patients can access because of the contracts they set up with providers.
The task force Mendell assembled last spring, through his nonprofit group Shatterproof, also includes top names in policy and advocacy: Don Berwick, former director of the Centers for Medicare and Medicaid Services; Michael Botticelli, former director of the Office of National Drug Control Policy; and former ONDCP deputy director Tom McLellan, among others.
In crafting its eight recommendations – released earlier this month – the task force drew heavily from the November 2016 U.S. Surgeon General’s Report on Alcohol, Drugs and Health. Among the evidence-based recommendations are universal screening, coordinated physical and mental care and, perhaps most importantly, access to FDA-approved medications.
The next step is for insurers to start promoting these principles in specific ways and on a defined timeline, said Josh Rising, director of health-care programs at The Pew Charitable Trusts, which is hosting the task force meetings.
For example, he’d like to see insurers ease the prior authorization process patients must go through to obtain three medications — methadone, buprenorphine and naltrexone — shown to be effective in treating people with opioid addiction. Insurers can identify which health providers tend to prescribe these medications.
“Payers play a key role in driving treatments,” Rising said.
Mendell lost his son, Brian, in 2011 after seeking out a series of providers who presented conflicting approaches to the role of medication in treatment. Brian was showing marked improvement at a treatment program in Arizona, where he was finally prescribed suboxone along with also receiving counseling for anxiety. But when Brian transferred to an outpatient program in Los Angeles some months later, and pressured by his doctors to phase down his medications, things took a turn for the worse.
That resistance to using medication for substance abuse disorders is one of chief things that needs to change, Mendell stresses.
Clinical research indicates that patients given medication are more likely to recover than if they’re only treated with residential stays or a 12-step program. But because providers are still resistant to prescribing these medications, fewer than half of all people in the United States who could benefit from addiction medication are able to access it, according to research by Pew.
“This is done for all other diseases,” Mendell said. “It’s just not done for addiction.”
The eventual goal is for the recommendations to be adopted by nonprofit groups — like the National Quality Forum and the National Association of Healthcare Quality — that create widely accepted standards of care. And then for Medicare and Medicaid – the government’s two big health insurance programs – to come on board too. (Some state Medicaid programs, for example, don’t cover all three of those medications used in substance abuse treatment.)
But for now, the task force is focusing on the major insurance companies because they can sometimes adapt more quickly than public programs, which often take years to assume new approaches, Rising said.
“We identified private payers for this particular task force in part because there was a sense that they might be more nimble,” Rising said.
To Mendell, that’s the quickest and most likely way to start getting helpful treatment to the estimated 21 million Americans who abuse opioids. The problem is acute; fatalities have multiplied in recent years. The number of deaths involving opioid overdoses tripled between 1999 and 2015, according to CDC data.
“It’s a 9/11 every eight or nine days and no one is talking about it,” Mendell said.