Challenge
In 2022, the California Advancing and Innovating Medi-Cal (CalAIM) initiative was launched to improve the health and well-being of Medi-Cal enrollees with complex needs, including improving the quality of outcomes, advancing equity, and reducing health disparities related to mental health and Substance Use Disorder (SUD) treatment. Pharmacotherapy has become widely accepted over the past decade as a leading treatment for Opioid Use Disorder (OUD); unfortunately, access to Medication for Addiction Treatment (MAT) remains limited, and the need for MAT exceeds its availability.
As part of California’s broader initiative, the California Commission for Behavioral Health, California Institute for Behavioral Health Solutions (CIBHS), and the Los Angeles County Public Health Substance Abuse Prevention Control (SAPC) have entered into a multi-year partnership to design and facilitate training and assistance to increase prescriber capacity and increase access to MAT beyond OUD to include other SUDs (e.g., alcohol, nicotine).
Solution
The SAPC MAT Prescribing Clinician startup project addresses substance use in California by removing barriers and improving access to MAT through a financially sustainable model. The objectives of the pilot project are to:
- Increase the availability of MAT in the SUD Specialty System of Care by increasing the number of prescribers.
- Explore whether Medi-Cal reimbursement rates will support and sustain the salary and associated costs of prescribers in the county’s provider network.
- Identify best practices for integrating prescribers and medical services into traditionally non-medical programs in small, medium, and large counties.
- Identify any barriers to this process concerning Incidental Medical Services (IMS) certification, recruitment of prescribers, and billing for MAT and related medical services.
CIBHS has contracted with the NIATx Foundation to provide six of the twelve coaches, who support the project and apply their expertise in MAT and NIATx evidence-based practice implementation. These coaches are focused on advising addiction treatment providers on best management practices for implementing MAT treatment. This includes clinical skills (e.g., which medications to prescribe, how to use them); workflows to effectively provide MAT; billing mechanisms to accurately capture services (e.g., Medi-Cal); and leadership support.
Specifically, coaches provide the following training and technical assistance (TTA):
- Coaching calls: Schedule regular calls with assigned sites to assist providers in designing an integrated care model and navigating the implementation process.
- Monthly collaborative calls: Attend and facilitate training and small group discussions.
- Technical assistance and resource development: Collaborate with the CIBHS project team to develop training modules and resources.
- Quality improvement (QI) training: Provide consistent training on best practices, NIATx process improvement, and business models to support expansion.
Outcomes
This project is pushing forward the progressive trend to increase the use of This project is pushing forward the progressive trend to increase the use of pharmacotherapies and expand their use to other SUDs beyond OUD (e.g., alcohol and nicotine). With year one establishing the baseline, the project will measure outcomes in the following areas in the next fiscal year:
- Increased prescriber capacity.
- Increased access to MAT Education, within the provider agency, and broader care community.
- Broadened the uses of MAT to alcohol and nicotine use disorders.
- Increased the frequency of MAT use for all SUDs.
Offering MAT further offers a business opportunity and a competitive advantage in an increasingly competitive healthcare landscape, where providers and clinics seek to attract patients by offering valued services that improve patients’ continued recovery.