A Financial Model for Team-Based Opioid Use Disorder Treatment

Area of Science:

• Family Medicine
• Addiction Medicine
• Healthcare Economics

Background:

• Opioid use disorder (OUD) affects millions, with treatment access often limited by a lack of team-based care in office-based opioid treatment (OBOT).
• Implementing OBOT in a family medicine setting presents financial challenges for non-billable support services.

Purpose of the Study:

• To develop a financial model for integrating non-billable OBOT support staff within a family medicine practice.
• To assess the financial viability of funding support staff through increased patient volume and revenue in an OBOT program.

Main Methods:

• Retrospective chart review of OBOT patients from July 2015 to December 2016.
• Analysis of changes in medical visits per patient per month pre- and post-OBOT implementation.
• Evaluation of visit coding levels and patient insurance types (Medicaid, private, self-pay).

Main Results:

• A net increase of 1.93 medical visits per patient per month was observed post-OBOT (P < .001).
• The majority of patients were insured by Medicaid (14/23).
• Financial projections indicated that treating existing and new patients could generate significant revenue ($1,439-$1,677 per patient annually, assuming Medicaid reimbursement and 20% cost of business).

Conclusions:

• Revenue generated from increased patient visits in a fee-for-service model can financially support the hiring of team members for non-billable OBOT services.
• This model demonstrates a sustainable approach to expanding team-based care for opioid use disorder within primary care settings.