CareFirst BlueCross BlueShield is partnering with Navigator Healthcare to provide members with improved SUD care navigation, helping them access appropriate and in-network treatment for substance use disorder quickly and efficiently. This collaboration reflects a growing trend among payers to simplify the complex behavioral health and SUD system for their members.
24/7 Access to Guidance
Under this partnership, CareFirst members can contact Navigator Healthcare’s team 24/7. The team, staffed by licensed clinicians, guides patients through the often confusing landscape of treatment options. From detox and residential programs to partial hospitalization, intensive outpatient care, and medication-assisted therapy, SUD care navigation ensures patients are matched with the right level of care for their needs.
“I think, like a lot of folks in health care, we assume, incorrectly, that consumers know all the special terminology and acronyms that we use in our day-to-day lives,” said Brian Wheeler, vice president of provider collaboration and network transformation at CareFirst. “We talk internally about residential treatment, detox, medication-assisted therapy, and partial hospitalization. What the public knows is people go to rehab. They don’t know anything more than that. That’s where SUD care navigation becomes critical.”
About CareFirst
CareFirst, a nonprofit health company and independent licensee of the Blue Cross Blue Shield Association, serves 3.6 million members across Maryland, Washington, D.C., and Northern Virginia. The partnership with Navigator Healthcare aims to help patients understand the system better, speed up access to care, and ensure they are guided to evidence-based programs.
Navigator Healthcare’s Role
“It’s a chronic condition. Very complex individuals left to their own devices will not necessarily land in evidence-based programs,” said Deb Adler, CEO and founder of Navigator Healthcare. Through its 24/7 resource center, the company provides personalized guidance, breaking down clinical terminology into plain language. Patients can secure appointments for treatment within 48 hours, supporting rapid intervention. This is a core component of effective SUD care navigation.
Navigator Healthcare, founded in 2019, specializes in guiding individuals affected by SUD through multiple levels of care. Patients may transition from residential programs to partial hospitalization to intensive outpatient programs, or step back up into higher-acuity care if necessary. The platform also monitors provider capacity, ensuring patients are referred to treatment centers with availability, another key element of streamlined SUD care navigation.
Who Can Access the Program
The program is available to CareFirst members aged 13 and older, covering commercial, Medicare, and Federal Employee Program members with no out-of-pocket cost. Navigator Healthcare supports patients, family members, primary care physicians, emergency room staff, and law enforcement advocating for individuals in need of care.
Addressing a Growing Need
With rates of SUD on the rise in the U.S.—46.3 million people aged 12 and older affected, according to the Substance Abuse and Mental Health Services Administration (SAMHSA)—this initiative addresses a critical gap in access to treatment. Yet, 94% of individuals with SUD do not receive care. Programs like this demonstrate the life-saving potential of robust SUD care navigation.
“This is a service that is going to actually save people’s lives,” Wheeler said. “With opioids and fentanyl driving overdose rates, I think that’s extremely likely to be the case.”
Previous Navigation Efforts
CareFirst has previously explored navigation partnerships, including a collaboration with Headway to help members find mental health clinicians. “It is difficult for consumers to navigate behavioral health, substance use, or physical medicine systems,” Wheeler said. “Opportunities like this make it easier to access care and highlight the value of SUD care navigation.”
Improving Outcomes Through Navigation
By combining the resources of a major payer with Navigator Healthcare’s licensed clinician network, CareFirst aims to provide comprehensive, patient-centered guidance. With 24/7 support, same-day or next-day appointments, and ongoing transitions through levels of care, this program exemplifies how SUD care navigation can improve outcomes and save lives.
