Newsroom | Collaborative Care

Pilot Peer-Support Program Guides Members Through Recovery

Stress from the COVID-19 outbreak is causing more alcohol and drug use in general — and making it harder for people struggling with addiction to stay sober.

A survey by the Centers for Disease Control and Prevention found 40% U.S. adults were struggling with mental health issues or substance use because of the pandemic. Of those survey respondents, 13% said they had started using or increased their substance use to cope with COVID-19 related stress.

Clinical teams at Health Care Services Corporation have studied the challenges associated with addiction and developed programs to connect members with resources they need to stay sober. Earlier this year, the company launched a one-year pilot program to help a limited number of members access the support they need after leaving inpatient treatment facilities.

The program links these members to state-certified peer support specialists — people who have been in recovery and are uniquely qualified to understand members’ addictions and relapse triggers, guide them toward long-term solutions and reduce repeated inpatient admissions for drugs or alcohol.

“Hopefully, members see someone very similar to themselves."

The pandemic has made such efforts critical for people who struggle to access services, networks and organizations they need to avoid relapse.

“Substance abuse is very difficult to treat,” says Scott Bender, director of clinical operations support at HCSC. Addiction, like other chronic diseases, often requires multiple facility admissions to help members control it, Bender adds. “We’re really trying to apply a strategy of looking at addiction more as a long-term disease.”

The pilot program is available to fully insured PPO group members with behavioral health benefits. Members admitted to Texas inpatient facilities are eligible for enrollment.

The company has enlisted a peer-support company based in Austin, Texas, that matches specialists it employs with members based on factors such as gender, age, substances used and religious background to strive for high compatibility and engagement. Initially, specialists meet members at least a week before their discharge to enroll them in the program and discuss plans for returning home, finding outpatient resources and improving relationships.

After enrollment, specialists continue meeting with members by video or phone to discuss relapse behaviors and offer support. Members in the program also have access to support 24 hours a day, seven days a week.

Peer specialists provide the essential follow-up guidance and support people often need to stay sober after leaving inpatient treatment, Bender says. So far, dozens of eligible members have enrolled in the program, which has reported a 75% engagement rate with support specialists.

“Hopefully, members see someone very similar to themselves,” Bender says.

The U.S. Substance Abuse and Mental Health Services Administration has found that peer-support programs can help people become engaged in recovery and reduce the likelihood of relapses.

“That personal contact is so critical,” says Bender, even as members and peer-support specialists meet virtually to limit potential coronavirus exposure. “The peer-support specialists are checking on the member’s overall health and mental health.”

A similar HCSC peer-support program helps Medicaid members in one state connect to doctors and other resources to begin recovery and stay out of the hospital.

Three years ago, HCSC’s plan in New Mexico found almost a third of emergency room visits by its Medicaid members were related to substance use and mental illness. Peer-support specialists employed by the plan now target members who have sought emergency room care between two and eight times in one month.

Since that program’s launch, emergency room visits plummeted among the program’s participating members. The number of those members readmitted to hospitals within 30 days of receiving care also dropped.

If the Texas-focused pilot achieves lower ER visits and facility admissions, HCSC may continue the effort and may expand it to other member groups.

“We’re always looking for ways to better serve our members,” Bender says.

Health Care Service Corporation, a Mutual Legal Reserve Company.