Treating people for addiction in Panama City, Florida in a residential rehab program comes with many challenges. One major issue in Florida is that some of the best drug and alcohol rehabs in the state do not treat any Medicaid patients at all. Other issues surround logistical problems and bureaucracy difficulties in Florida’s government subsidized health insurance programs. Some of the top drug and alcohol treatment programs in Florida have never taken Medicaid or Medicare patients at all, and others have struggled to get paid by Medicaid vendors in the past and have had to make difficult decisions about whether to continue providing treatment to these patients. That leaves people on Medicaid in the state of Florida in tough circumstances if they need the best drug and alcohol rehab treatments.
This has led many experts to turn to an approach called “Cascade of Care” (CoC) to best meet the challenge of the opioid epidemic, including the opioid crisis currently happening in Florida and surrounding states like Alabama and Georgia. The University of South Florida researched the possible benefits of using cascade of care in Florida to address the shortfalls surrounding Medicaid patients and addiction treatment. Today we will discuss what that means to the people of Florida, especially those who may be struggling with substance use disorders.
Turning to Cascade of Care
CoC was initially developed in the previous 2 decades, and in 2017 health care professionals began to identify CoC as a possible response to the opioid crisis, which had become the deadliest aspect of the larger addiction crisis in the United States. Cascade of Care (CoC) is an improved framework of care for the identification and treatment of people with opioid use disorder.
According to NIDA,
“A broad, national OUD Cascade of Care framework consistently applied across states could provide a structural model to help communities identify which population group needs what kind of intervention.”
I will give more information on what that means before discussing the ways that USF would like to apply this to Florida and Medicaid patients. CoC comes from the world of HIV and AIDS treatment. HIV and AIDS, similar to the opioid crisis, were once a new health epidemic that was poorly understood outside of experts in the field; that epidemic was quickly taking thousands of more lives each year in the 1980s and 1990s. The biggest change that CoC brought to the HIV/AIDS crisis was a huge shift towards prevention, education, and monitoring, rather than just treating people after they had gotten sick. Anyone who is old enough to remember the 1990s will remember large public campaigns to teach people about safe sex and HIV testing and awareness. The CoC model worked for AIDS and HIV, and the deaths decreased greatly over the course of the 90s. The opioid crisis needs to find a way to repeat that success story, and many health professionals believe cascade of care in places like Florida could lead the way to that success.
Cascade of Care for the Florida Opioid Crisis
The first step in the Florida plan is something I have been talking about on this blog for several years, which needs to happen immediately across the country. Medication-assisted treatment (MAT) must immediately be expanded and the backwards and outdated rules and laws surrounding the prescription of Suboxone (Buprenorphine) must be changed in Florida and elsewhere. More doctors must be able to prescribe Buprenorphine, and those doctors must be allowed to prescribe the drug to many more patients, provided they follow guidelines regarding best practices for MAT treatment. The best drug and alcohol rehabs in Florida, including Florida Springs in Panama City, are adept at treating patients with the inpatient 30-day model, but there is more than one way to find lasting recovery, and MAT works best for some people.
USF goes on to describe the need for
“Continuous coverage, adequate provider capacity, ease of access in terms of location and time, treatment that addresses patient needs, preferences, and abilities to pay for, obtain, and use medications on schedule, and ongoing efforts to support treatment adherence are all necessary to provide care that improves health.”
As the USF study and other experts have indicated, we have a substance use disorder treatment system which works against patients and often treats them terribly. Some providers, and the system at large, tends to treat people with addiction more like criminals than like patients with any other disease. That stigma and attitude must change for the faulty rulemaking apparatus to change. The third section of the USF plan calls for better tracking of status and outcomes for patients requiring substance abuse treatment, including within the Medicaid system in Florida. The plan would require largescale tracking of “claims data”, or the information about how many people are seeking and receiving treatment, and how that treatment is progressing. There are many finer points to discuss in the plan itself and the use of cascade of care for Florida substance use disorder patients, but the University of South Florida CoC plan seems to be well positioned to quickly improve addiction treatment in Florida, including for people with Medicaid.
By T.A. Cannon
“Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality.” Kimberly Johnson et. al, University of South Florida.
National Institute of Health Cascade of Care Article. Retrieved from: https://nida.nih.gov/news-events/news-releases/2019/01/cascade-of-care-model-recommended-for-opioid-crisis