Screening and Brief Intervention SBI for Alcohol Problems

Screening and Brief Intervention (SBI) for Alcohol Problems: Health Plan Policies and Payment for SBI Services Laura L Jacobus-Kantor, Ph. D, Eric Goplerud, Ph. D, Tracy Mc. Pherson, Ph. D, Delia Olufokunbi Sam, Ph. D Center for Integrated Behavioral Health Policy Department of Health Policy George Washington University Medical Center Abstract Results Background: In 2009, The National Business Coalition on Health (NBCH) included a number of questions on health plan policies surrounding screening and brief intervention (SBI) in their annual survey, the e. Value 8 RFI. These questions represent a set of standards for alcohol care that were developed collaboratively by the business community, health plans, and a panel of substance abuse experts. By increasing awareness and the attention given to alcohol problems, and specifically on SBI for alcohol problems, NBCH hopes to increase the availability and quality of these services in a variety of settings. Methods: Ninety United States-based health plans, representing over fifty million covered lives, responded to the 2009 e. Value 8 RFI. Each of these plans responded to a number of questions that detailed plan policy on SBI issues. Results: Most plans (77%) reported working directly with hospital or trauma centers to encourage SBI for alcohol problems. The most common methods used by plans were disseminating guidelines for SBI in trauma settings (62%), offering payment for SBI services delivered in an emergency setting (60%) and offering SBI training to trauma center practitioners (20%). Three-quarters of plans (75%) reported that they would reimburse for SBI services rendered by non- behavioral health providers. Additional results detailing plan policies for SBI services in other settings are also presented. Conclusions: While much work remains to be done in this area, health plans have begun to adopt policies that encourage SBI services in a variety of settings. Collaboration With Trauma Centers and Emergency Rooms: Most health plans (77%) report working collaboratively with emergency rooms (ERs) and/or trauma centers (TCs) to promote SBI services. While most plans reported providing hospitals with general guidelines for SBI , relatively few (20%) provided hospital personnel with any plan-sponsored training on SBI services, and almost no plans (3%) reported providing physicians or other health care providers with financial incentives for SBI activities. The percentage of plans reporting that they will reimburse for SBI services using the CPT codes was significantly higher in 2009 than in 2008. In 2008, 57% of plans reported reimbursing for SBI services rendered by non-behavioral health providers, and 54% of plans reported reimbursing for SBI services rendered by behavioral health providers. Overall, collaboration with TCs and ERs around SBI issues increased between 2008 and 2009. In 2008, only 40% of plans reported providing ERs/TCs with guidelines for SBI services, and only 32% reported providing payment for SBI services offered in the ER/TC. Introduction Beginning in 2008, CPT codes approved by the American Medical Association went into effect that allow physicians and other health care providers to bill for SBI services. Since the introduction of these codes, the National Business Coalition on Health has updated its annual survey of commercial health plans to include a number of questions asking plans to describe their policies and coverage for SBI services. Methods Number of Codes Paid: Plans were also asked to report the actual number of claims for Screening and Brief Intervention services that were paid during the 2008 calendar year. No plans reported paying more than 300 claims, and many reported paying less than 100 claims. 90 United-States-based commercial health plans, representing over 50 million covered lives, responded to the 2009 e. Value 8 RFI. e. Value 8: Is a uniform, annual assessment of the quality of care for a range of health concerns provided by health plans. l. Provides a repository of benchmarking data for approximately 100 health plans nationally. l Is a national standardized health plan evaluation process developed with input from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, the George Washington University, and the United States Substance Abuse and Mental Health Services Administration (SAMHSA). l. Responses are authenticated by trained e. Value 8 staff to ensure the validity of the information reported by the health plans. Conclusion l Plan Reimbursement for SBI Services: Most plans reported reimbursing, or planning to reimburse, for SBI services using the new CPT codes approved by the American Medical Association. A slightly higher percentage of plans reported that they would reimburse for services rendered by non-behavioral health providers (75%) than reported that they would reimburse for services rendered by specialty, behavioral health providers (66%). One-third of plans (33%) reported that they did not reimburse, or plan to reimburse, any providers using these new codes. While most plans reported providing reimbursement for SBI services provide in both emergency and primary care settings, relatively few plans are taking active measures to ensure that providers are rendering these vital services. Only onefifth of plans report providing emergency personnel with training on SBI practices, and almost no plans provide physicians and other health care personnel with financial incentives to provide SBI as a part of normal care. Results from the e. Value 8 RFI also suggest that health plans and providers have been slow to move these codes into routine practice. While most plans report providing reimbursement for SBI services, only a miniscule number of claims were actually paid during this first year. Given the number of Americans served by plans responding to the e. Value 8 in 2009 (over 50 million) it is clear that these codes are not being fully utilized by providers or health plans, and that more education and publicity is needed on both the necessity and utility of these codes.