A combination of new treatment options, effective approaches to screening and intervention, and changes in reimbursement practices promises to transform the way that health care deals with alcohol use disorders. These new approaches include screening and brief intervention (SBI), new medications for treating alcohol dependence, and new procedure codes.

Screening and Brief Intervention Improves Care, Reduces Costs
According to research conducted by Ensuring Solutions to Alcohol Problems, a project based at The George Washington University Medical Center and funded by the Pew Charitable Trusts, less than one percent of health plan members are diagnosed with alcohol use disorders. Based on general population rates, health plans should be diagnosing at least four or five times as many members with alcohol problems.

“Health plans identify between 40 and 70 percent of patients with chronic diseases like depression, diabetes, and hypertension. Our findings indicate a systemic failure to address alcohol-related problems,” says Eric Goplerud, PhD, Director of Ensuring Solutions.

Even in health plans with specific protocols to identify and treat people with alcohol-related problems, only 44 percent of members identified as alcohol dependent attend even one treatment session within 14 days after diagnosis.

“Imagine discovering an illness that kills about 85,000 people annually, and then imagine that we identify only one in 20 of those people—even though we have effective treatments that can be administered by primary care physicians or specialists,” says Goplerud. “Alcohol use disorders are that illness. Yet we accept low rates of identification and treatment. Our approach to alcohol treatment is unlike what we expect and demand for treatment of diabetes, high blood pressure, asthma, or virtually any other health condition.”

The costs of alcohol misuse and dependence show up in increased health care utilization, expensive emergency room visits, and more hospitalization. Health plans actually lose money by not responding to the needs of those with alcohol-related problems.

In an analysis of data from 250 health plans nationwide, Ensuring Solutions researchers found that a health plan with 100,000 beneficiaries would average more than 7,000 members with alcohol use disorders every year. Left undiagnosed and untreated, these members would increase health plan costs by more than $12 million annually.

Health plans could improve care and save money by conducting screening and brief intervention, a technique combining the use of validated screening instruments and short-term intervention to reduce or eliminate harmful alcohol use.

“If a large health plan conducted SBI with the intent of identifying 50 percent of members with alcohol problems, the plan would receive a return on investment of almost 70 percent,” reports Goplerud. “SBI has been proven to help risky drinkers change their behavior before they become alcohol dependent, and it helps get people with alcohol dependency into treatment.”

To estimate how much your health plan could save while helping people with alcohol-related problems, visit the Ensuring Solutions Alcohol Cost Calculator for Health Plans at http://www.alcoholcostcalculator.org/healthplans.

New Practice Standards Lead the Way
The National Quality Forum (NQF), a membership organization established as a public-private partnership between national, state, and local health groups, has set new standards for treatment approaches for alcohol and other drug-related problems. The new standards include SBI as well as the use of pharmacological medical management to treat alcohol use disorders.

The standards encourage annual screening for at-risk drinking, alcohol use problems, and alcohol-related illnesses. They also recommend using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guide for alcohol screening, Helping Patients Who Drink Too Much: A Clinician’s Guide.

The NIAAA updated the Clinician’s Guide in 2005 to encourage health care professionals to incorporate alcohol screening and intervention into their practices. Featuring new information on pharmacological approaches to treatment, the Guide walks providers through the process of screening patients for alcohol misuse and addiction. Providers who identify problem drinkers then conduct a brief intervention based on motivational interviewing techniques.

The Guide also provides assistance to physicians who diagnose alcohol dependence, emphasizing the importance of longer-term interventions for patients diagnosed with alcoholism. These interventions may include a wide variety of out-patient and residential treatment options, in addition to the use of medications like Depade®, ReVia®, Vivitrol®, Campral®, or Antabuse® to aid recovery.

Medical Coding and Reimbursement
Medical procedure coding systems are responding to the changing diagnosis and treatment environment. The Centers for Medicare and Medicaid Services (CMS) recently approved new Healthcare Common Procedure Coding System (HCPCS) codes. The new policy adds two new codes to the HCPCS Level II coding system that Medicaid, Medicare, and other insurers use to process medical insurance claims.

Practitioners can now use one of the new codes for screening and another when they provide brief intervention so that they may be reimbursed for their services. In addition, alcohol treatment medications have been assigned specific HCPCS codes.

Most importantly, the American Medical Association is now considering a current procedural terminology (CPT) code for screening and brief intervention. If approved, this code will make it easier for providers to document and request reimbursement for conducting SBI.

In the meantime, Ensuring Solutions offers an SBI reimbursement guide to help medical coders and office personnel document procedures related to screening and brief intervention. This guide can be accessed by visiting the Ensuring Solutions website at http://www.ensuringsolutions.org and clicking on “Resources,” then “Screening and Brief Intervention.”

According to Goplerud, “Effective treatment of alcohol-related problems is possible. Managed care organizations need to ensure that screening and treatment are incorporated into standard patient care procedures. Doing so will reduce costs and save lives.”

*Article reprinted with the permission of Managed Care Outlook, a publication of Aspen Publishers. Copyright © 2007, Aspen Publishers, Managed Care Outlook, Volume 20, Number 14, July 15, 2007. Posted with permission.