Opiate addiction treatment hubs save money, state says

Beth Tanzman (left), Vermont Blueprint for Health assistant director, and Barbara Cimaglio, deputy commissioner for  Alcohol and Drug Abuse Programs, speak to the Green Mountain Care Board. Photo by Laura Krantz

Beth Tanzman (left), Vermont Blueprint for Health assistant director, and Barbara Cimaglio, deputy commissioner for Alcohol and Drug Abuse Programs, speak to the Green Mountain Care Board. Photo by Laura Krantz/VTDigger

Treating opiate addiction through the state’s new regional center model will save money, according to a state analysis. But there is no study to show whether the system is more effective, officials said Thursday.

Meanwhile, treatment providers at some residential facilities are frustrated by the state’s shift to more outpatient services; they say residential treatment is vital and will save more money in the long term.

The hub and spoke system is comprised of seven hubs, or regional centers, throughout the state that provide medication-assisted treatment along with counseling and other services, as well as spokes, local doctors who also treat addicts and link them with medication and counseling.

The Shumlin administration this year proposed spending an extra $8 million in next year’s budget on the hub and spoke system, which was created in 2012. The Legislature this week is wading through the details of where that money would come from.

Funding will come primarily in the form of Medicaid dollars that will be saved by treating patients through hubs, according to a financial analysis by the Department of Vermont Health Access.

DVHA has estimated the state next year will save $6.7 million by treating patients through hubs, and plans to reinvest that money in the hubs to serve more patients.

To calculate the $6.7 million in anticipated savings, DVHA surveyed 490 patients who were admitted to the first hub — the Chittenden Clinic in Burlington. Officials analyzed two years of Medicaid claims data for those patients before they were admitted to a hub, then one year of claims data for the year following their admission, according to DVHA Commissioner Mark Larson.

The results show it cost less to treat patients when they were treated through the hub, Larson said.

As a result, DVHA has projected that for the 2,164 patients estimated to be served statewide, the savings will be $6.7 million. There will also be $1.3 million in new federal funds, Gov. Peter Shumlin has said.

According to the DVHA analysis, while there will be an overall savings by moving patients to hubs, some areas of treatment will cost more, including home health and durable medical equipment.

The state expects savings in areas such as residential treatment, independent lab work and outpatient payments, according to the DVHA analysis, which was presented to the House Appropriations Committee.

While data reflect that hubs save money, there has been no analysis of whether patients in the system have more success in battling addiction. The system is less than two years old and officials acknowledge it is a work in progress.

The state is working on developing a way to track patients’ success, Beth Tanzman, who oversees the spoke program for DVHA, told the Green Mountain Care Board on Thursday, during an overview of the hub and spoke program.

Gathering results

The Department of Corrections has agreed to provide DVHA with incarceration data so it can cross-reference hub and spoke patients, Tanzman said. DVHA is also seeking employment data from the Department of Labor and Department of Children and Families data about the out-of-home custody of kids, Tanzman said.

“It may actually be the one of the first times we can really combine the health and services measurement strategy together,” Tanzman.

The DVHA analysis shows an anticipated $967,654 reduction next year in money spent on inpatient treatment.

However, like any budget decision, that number represents a “leap of faith,” said Rep. Kitty Toll, D-Danville, a member of the House Appropriations Committee, which is responsible for the Alcohol and Drug Abuse Program (ADAP) budget.

“They’re basing it on data, but I think that there’s a lot of variables that can have an impact,” she said, adding that she is not convinced that there will be a reduction in the amount of inpatient services needed.

The budget bill her committee is considering this week instructs the Joint Fiscal Office to review the 15-day pre-approved residential substance abuse treatment limit for adult Medicaid recipients.

The Joint Fiscal Office will consider best practices, private insurance practices as well as the relationship between the number of days in residence and patient outcomes, according to the bill.

The budget bill will also include language asking the Agency of Human Services to report back to the Legislature on the results of the plan to invest $8 million in hub treatment.

The study will need to show whether the $6.7 million expected savings was realized as well as treatment outcomes, Toll said.

Meanwhile, some residential treatment centers say the shift to outpatient treatment at hubs and spokes is needlessly penalizing residential facilities.

While not all patients need treatment at a live-in facility, some do, they say.

Last spring and summer, the state reduced the number of residential treatment days that Medicaid covers to 15.

That is about half of what many patients need, said Rick DiStephano, vice president for clinical services at Valley Vista, a residential treatment center in Bradford.

Facilities can ask ADAP for an extension and more than 90 percent of the time it is granted, according to the treatment facilities and ADAP.

DiStephano said the state likely will see a savings after this year, because Valley Vista isn’t treating patients for as many days.

When Valley Vista’s 18-month contract ($4.9 million annually) ends this year, it expects not to have billed about $600,000 in treatment services, DiStephano said.

Since implementation of the 15-day length of stay, Valley Vista has had empty beds, DiStephano said. Of its 80 beds, about 50 are full. Two weeks ago about 30 were full, he said.

Meanwhile, requests for readmission have risen, he said. In the long run, the state could save money by treating patients longer in residential facilities rather than paying for medication they receive in outpatient hubs and spokes.

“It’s like the state has a Suboxone intoxication,” DiStephano said.

Health Department officials say they settled on 15 days by looking at the average length of stay among the state’s three residential treatment providers, Valley Vista, Maple Leaf Farm in Underhill and Serenity House in Wallingford.

“We’re really trying to get away from that kind of one-size-fits-all,” said Barbara Cimaglio, deputy commissioner for alcohol and drug abuse programs.

Laura Krantz

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14 Comments on "Opiate addiction treatment hubs save money, state says"

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Dave Bellini
2 years 3 months ago
But, isn’t it a fact that this will wind up costing more money? This form of “treatment” is just “substitution therapy”. Substitute the heroin/Oxy addiction for a methadone/Suboxone addiction. Real treatment aims to end addiction not maintain it. This is great for the drug companies however. They sell the legal, highly addictive drugs to people who already struggle with addiction. More and more people become addicted to THEIR drugs under the guise of “treatment.” They’re just high tech opium dens. Eventually folks will realize that this model will lead to a greater percentage of addicted citizens.
Marc Latzky
2 years 3 months ago

Dave, you are so right. I have also heard that they don’t qualify patients, so new people sign up and become new users of methadone, where they previously had no drug problem. This is drugs for votes and is one of the worst wastes of money and resources. It’s fits the state plan of creating needy residents as a profit center for administrators and drug companies.

Ellen Fiske
2 years 3 months ago

The addictions to the legal drugs just change who makes the huge amounts of money off of them, and who pays for them. Taxpayers, instead of robbery victims! We have to be kidding if we think this solves anything. Addiction is still addiction, regardless of the legal status of the substance. This is almost as idiotic as the “mental health” system, except for the part where they force the patients into addiction to begin with.

Fred Woogmaster
2 years 3 months ago

Growth industries have played a significant role in the shaping of public policy over the decades – to the detriment of the citizenry. Is this yet another?

Janice Prindle
2 years 3 months ago
Seems to me from all that I have read on Digger and elsewhere that there’s plenty of evidence this approach doesn’t work, and ends up costing in the long run, not just in dollars– but in the damage to lives of people who need more time in residential treatment to lick an addiction. This is not just a physical process, for which we can simply substitute a legal drug for an illegal one. There’s an underlying reason why a person gets caught up in drug abuse to begin with, and that takes time to sort out, to rebuild damaged souls… Read more »
Ellen Fiske
2 years 3 months ago
A lifetime of dependency on a legal drug is more expensive than a few more weeks in residential treatment if they need it, and the quality of life of the addict is much better if they aren’t continuing to be drug dependent (just to a different drug). This same moronic approach is echoed in the mental health system, where they are trying to make the hospital stays shorter by making the decision sooner, to force the patient into drug dependency, giving the patient less time to try to recover by other methods, first. Save a few dollars on length of… Read more »
Jennifer Brown
2 years 3 months ago

Aren’t these treatment facilities just a way for folks to get out of trouble? “I’m a addict. I need treatment, not jail.” Seems to me, that a percentage of those there are mandated to be there by a judge and not serious about the actual treatment. Hence, the results of treatment are not realized. And the offender is back at it after release. Call me cynical….

Seth Henry
2 years 3 months ago
I have no problem with the creation of adequate treatment facilities for addiction, however it seem to me that our approach to solving the problem should also include prevention. It is well known that 4 out of 5 opiate addicts (nationally) start out on prescription painkillers. It is also known that a small percentage of health care providers are responsible for a high percentage of the prescriptions (20%/80% in VA studies). We have a small state with a few provider networks. Why hasn’t the administration begun to address the problem by engaging the Health Community in reducing opiate prescriptions? There… Read more »
Ellen Fiske
2 years 3 months ago

And how about increasing our supply of natural opiates, which we generate when we exercise. More sports programs for kids, and not just the stars who make the varsity teams.

2 years 3 months ago

Congratulations Seth, You brought out the P word. Prevention in the home begins with the medicine cabinet which should be EMPTY of these medicines. Drug Take Back Programs work and a “not in my house” household policy is a key to reducing this demand driven process. Parents need to know that experimentation at home with opiates is the gateway to opiates at ages that usually include 5th and 6th grades.

Empty that cabinet everyone and secure your medication in a lock box if you still need it.

Fred Woogmaster
2 years 3 months ago

Thank you. Excellent advice.

Ellen Fiske
2 years 3 months ago

I was prescribed a strong painkiller for an injury and it was a huge dose, so I bit the pill in half and it worked just fine. I only needed that one dose, because then I got used to the pain and was OK. I threw the rest in the trash. Why do doctors prescribe such huge amounts of painkillers? Really, I was going to need a couple weeks of a huge dose?

Paul Lorenzini
2 years 3 months ago

it is cheaper to pay farmers to grow poppies then it is to pay law enforcement to clean up the mess of the poppy/oxycontin profiteers.

true or false?

Ellen Fiske
2 years 3 months ago

Good point- law enforcement will never win the battle on its own! It’s at an economic disadvantage!

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