The opioid epidemic remains one of the most pressing public health crises in the United States, with millions of Americans impacted by opioid use disorder (OUD). Treatment for OUD often centers around medication-assisted treatment (MAT), an evidence-based approach that combines FDA-approved medications with counseling and behavioral therapies. However, for many years, access to whole-person MAT — which integrates both medication and therapy — has been limited. Instead, patients often received medication alone without the counseling component that experts consider vital for long-term recovery. Health organizations like the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have long recommended that MAT should always combine medication with behavioral therapy. Despite these recommendations, insurers found that in many cases, patients were not receiving a comprehensive approach.
Anthem’s Discovery: Barriers to Whole-Person Care
Four years ago, Anthem-affiliated health plans (NYSE: ANTM) discovered a concerning gap in care: only 18% of members receiving MAT for OUD were accessing both drug therapy and counseling. The majority were only receiving medication. This limited approach left patients without the therapeutic support needed to address underlying mental health conditions, triggers, and behavioral changes crucial for recovery. Anthem set out to identify why so few patients were receiving the full spectrum of care. Their research uncovered several barriers:
- Provider availability: In many communities, there were not enough local providers offering both components of MAT.
- Screening practices: Primary care providers were not consistently screening for OUD or connecting patients to appropriate behavioral health resources.
- Lack of innovation: Traditional treatment models were often rigid, making it difficult for patients to access comprehensive, home-based, or telehealth options.
According to Dheeraj Raina, regional medical director and addictionologist for Anthem, overcoming these barriers required a combination of innovation, provider collaboration, and payment model reform.
Anthem’s Strategic Changes
To improve MAT outcomes and bring whole-person care to more patients, Anthem implemented several key strategies:
1. Expanding Telehealth MAT
Anthem began offering telehealth MAT programs across multiple markets, allowing patients to receive both medication management and counseling virtually. This move was particularly effective for rural communities, where access to behavioral health professionals has historically been limited. Telehealth eliminated geographic barriers and provided patients with greater flexibility, especially during the COVID-19 pandemic when in-person care was harder to access.
2. Standardizing Reimbursement Models
Anthem worked to standardize reimbursement for MAT services across both primary care and behavioral health providers. This removed financial disincentives that might prevent providers from delivering integrated care. By ensuring that both types of professionals were fairly reimbursed, Anthem encouraged collaboration and made it easier for patients to access both medication and counseling under one treatment plan.
3. Bundled Payment Arrangements
The insurer also developed bundled payments for practices offering MAT, rewarding providers who incorporated both medication and counseling into treatment. This model incentivized providers to focus on patient outcomes and comprehensive care rather than piecemeal services.
4. Encouraging Innovative Recovery Approaches
Anthem introduced comprehensive and home-based treatment models to meet patients where they are. These approaches provided flexibility for individuals balancing recovery with work, family, and other responsibilities. By tailoring treatment to real-world challenges, Anthem made it easier for patients to stay engaged in recovery.
The Results: Doubling MAT Metrics
The results of Anthem’s efforts have been significant. In just four years, the percentage of members receiving both drug therapy and counseling as part of their MAT plans more than doubled from 18% to 36%. These improvements were seen across 26 employer-based, individual, and Medicaid health plans. Anthem’s success shows that systemic barriers to care can be addressed with a combination of innovation, payment reform, and technology. By emphasizing whole-person care, the insurer helped thousands of members access more effective treatment and improved outcomes for individuals struggling with OUD.
Why Whole-Person MAT Matters
The progress made by Anthem is important because research consistently shows that MAT works best when it includes both medication and behavioral therapy. Medication — such as buprenorphine, methadone, or naltrexone — addresses the physiological aspects of OUD, reducing cravings and withdrawal symptoms. Meanwhile, counseling and therapy tackle the psychological and behavioral components of addiction, helping patients build coping skills, address trauma, and manage triggers. Without counseling, patients may struggle to make lasting changes even if cravings are under control. Whole-person MAT addresses the biological, psychological, and social dimensions of addiction, giving patients a better chance at long-term recovery.
Challenges Ahead
While Anthem’s success is promising, challenges remain in ensuring consistent access to whole-person MAT across the nation. Some of these challenges include:
- Provider shortages: Many regions, especially rural areas, still lack behavioral health professionals trained in addiction care.
- Stigma: Both patients and providers may carry misconceptions about MAT, believing it substitutes one addiction for another.
- Insurance variability: Not all insurers have implemented bundled payments or standardized reimbursement for MAT, limiting access in certain markets.
- Sustainability: As telehealth policies continue to evolve post-pandemic, there is uncertainty about whether virtual MAT programs will remain widely covered.
Anthem’s Broader Role in Behavioral Health
Anthem’s success in expanding MAT reflects the insurer’s broader efforts to improve behavioral health care. Across its affiliated plans, Anthem has emphasized integration between physical and behavioral health, expansion of telehealth, and the use of value-based care models. By focusing on innovation and whole-person treatment, Anthem is setting a precedent for other insurers to follow.
Looking Forward
The opioid crisis continues to evolve, with new challenges emerging such as the rise of fentanyl and other synthetic opioids. As the landscape changes, insurers like Anthem will play a critical role in ensuring patients have access to effective, evidence-based treatment. Anthem’s experience demonstrates that doubling whole-person MAT engagement in just four years is possible with the right strategies. Moving forward, the goal will be to continue building on that progress, addressing remaining barriers, and ensuring that every patient with OUD can access the comprehensive care they need.
Conclusion
Anthem-affiliated health plans have shown that with intentional reforms, access to whole-person MAT can be dramatically improved. By doubling the percentage of patients receiving both medication and counseling, Anthem has helped more people access life-saving, evidence-based care. This progress not only supports better individual outcomes but also contributes to addressing the opioid epidemic on a broader scale. The journey is far from over, but Anthem’s results provide a roadmap for insurers, providers, and policymakers working to make comprehensive treatment the standard of care for OUD.
