As Opioid Epidemic Surges, Burwell Commits $100M in New Funds for Substance Abuse

July 27, 2015

The HHS Secretary told the National Governors Association that she needed their help in fighting substance abuse and in moving the healthcare system from a volume-based to a value-based system.

HHS Secretary Sylvia Mathew Burwell announced Saturday that her department will make more than $100 million in new funds available to combat substance abuse, with a special focus on opioid addiction, as death rates from heroin have tripled since 2007 and abuse has reached crisis levels in many parts of the country.

Burwell unveiled the new funding unexpectedly during remarks before the summer meeting of the National Governor’s Association, held in White Sulphur Springs, West Virginia, her native state. The announcement came during wide-ranging talk on “healthcare transformation,” which not only covered the challenges of prescription drug and heroin abuse but also HHS’ efforts to move from volume-based to value-based reimbursement in Medicare, and especially its efforts to work with states that have not yet expanded Medicaid under the Affordable Care Act (ACA).

The talk was covered on C-SPAN Saturday evening. HHS later issued a statement on the substance abuse funding. The funding is in 2 parts: First, $11 million is available to state and community health centers for medication-assisted treatment through the Substance Abuse and Mental Health Services Administration. Second, the Health Resources and Services Administration will make $100 million available for improved the delivery of substance use disorder services, with a focus on medication-assisted treatment for opioid use disorder.

CDC recently issued a staggering report on the explosion of opioid prescription drug and heroin abuse, chronicling a death rate that has quadrupled since 2002, with most of that increase coming in the past 5 years. According to CDC, the rate of past-year opioid abuse or dependence significantly exceeded treatment capacity each year, increasing from 634.1 per 100,000 in 2003 to 891.8 per 100,000 in 2012.

In her remarks to the governors, Burwell said opioid abuse, “is not geographic; it’s not socioeconomic anymore,” relaying the reality that the problem has touched every corner of America.

Governors from both parties were highly receptive to her message. Governor Pat McCrory of North Carolina, said his state’s jails and prisons were filled with persons suffering from addiction, and Governor Mary Fallin of Oklahoma encouraged Burwell to create a mandate that prescription monitoring requirements, now in force in most states, become the norm for all Medicaid recipients.

“We want to work in partnership to come up with a viable solution,” McCrory said to Burwell.

Healthcare “transformation.” “For too long, our systems have failed to put the patient first,” Burwell said, but there are signs of progress. In the past year, hospital readmissions are down 8 %, the number of hospital-acquired infections is down 17%, and, thanks to the ACA, she said, the ranks of the uninsured have been reduced by 16 million people.

The Secretary discussed upcoming timelines within CMS for tying Medicare reimbursement to alternate payment models, which she described as a movement from “how much” to “how well.”

In January 2016, 30% of Medicare payments must be tied to accountable care organizations or bundled payments, with that share rising to 50% by 2018. She noted the recent rollout of an initiative to bundle payments for hip and knee replacements, among the most common procedures that Medicare funds.

For transformation to occur, Burwell said, “We need the support and participation of the states. State efforts can go a long way toward changing the status quo, so let us know how we can help.”

Medicaid expansion. Finally, Burwell said, “I wouldn’t be doing my job,” if she didn’t nudge those remaining states—there are now 20 left—that have not expanded Medicaid to households earning up to 138% of the federal poverty level. Seated before her were governors whose states have held talks on expansion—including McCrory and Missouri’s Jay Nixon—but have not yet come up with a waiver that will pass muster with the legislature.

McCrory, who praised Burwell and her staff for their responsiveness, brought up the topic of work requirements for recipients, which has been a stumbling block in the past.

Burwell responded that while it has been HHS’ position that “healthcare is not a conditional thing,” her department agrees with the principle of promoting work, and she did not close the door on McCrory’s idea. “We think you want work encouraged, and we think there are ways to do that,” she said.

In response to a question about rising premium rates in the individual market, Burwell said that was something HHS was watching very closely. Of greater concern, she said, is the cost of prescription drugs, and she called on Congress to give Medicare Part D the right to use its market power to negotiate better prices.