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Insurers Wake Up to the Costs of Treating Substance Use Disorder

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at September 14, 2016

Welcome to the Wednesday edition of SoberLawNews.com

Julie Appleby of Kaiser Health News (khn.org) wrote on September 12, 2016 about a study released by Fair Health about how spending relating to opioid treatment increased by 1300% from 2011 to 2015.

However, I think the Fair Health study (as reported at least) leaves an assumption on the table which requires a response.

In the article, Julie reports that the study concluded that:

“The nation’s ongoing opioid problem comes with staggering physical and emotional costs to patients and families. But the dollar cost to the health system has been harder to peg. Now a new report shows a more than 1,300 percent rise in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse. From 2011 to 2015, insurers’ payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million — a 1,375 percent increase.”

Robin Gelburd, president of Fair Health, a nonprofit databank that provides cost information to the health industry and consumers, was quoted as saying: “That really shows the stress on the health system and the impact on the individuals.”

Has anyone considered that perhaps this is due to the fact that the Affordable Care Act mandated that insurers cover behavioral health care for the first time in our nation’s history, and the Mental Health and Addiction Equity Parity Act demanded that coverage, services and reimbursements be made “on par” with medical health care?

It is not as if demand for services is new.  Americans have been demanding insurance coverage for services for decades, going back beyond the Kennedy Administration of the 1960’s.

“The surge in spending on patients with opioid diagnoses is likely a combination of factors, the report notes. As media attention focuses on drug dependency, more people may be seeking treatment. At the same time, prescription and illegal use of narcotics may also be increasing. The study found that emergency room visits and laboratory tests accounted for much of the spending. Based on claims volume, the fastest-growing set of services in terms of utilization were for alcohol or drug therapy. Lab tests, including checks for barbiturate or opioid use, were not far behind.”

Now that Americans are finally getting the help they have so desperately needed, our society is viewing the increase in behavioral health care expenditures as if there is an unpredicted tsunami of activity about to hit the marketplace.  Time to wake up.

“ ‘But the spending might also reflect a growing use of very expensive urine and blood tests when less expensive ones would be sufficient,’ said Dr. Andrew Kolodny, senior scientist at Brandeis University. ‘I worry about profiteering….We do need tests, but not the expensive ones. A lot of clinics are making extra money off these lab tests.’ ”

The full article can be found here.

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