Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model.

Area of Science:

• Health Services Research
• Addiction Medicine
• Primary Care Practice Management

Background:

• Opioid use disorder (OUD) is a significant public health crisis requiring accessible treatment options.
• Primary care settings are increasingly recognized as crucial for delivering OUD treatment, including buprenorphine.
• Understanding the financial implications of different OUD treatment delivery models in primary care is essential for widespread adoption.

Purpose of the Study:

• To determine the financial impact of alternative buprenorphine treatment strategies within primary care practices.
• To compare the cost and revenue implications of four distinct buprenorphine delivery models.

Main Methods:

• Interviewed 20 primary care practice managers to identify four treatment delivery approaches.
• Utilized a microsimulation model to estimate financial outcomes across diverse practice types (FQHCs, urban/rural non-FQHCs, non-poverty areas).
• Analyzed variations in patient type, payer mix, revenue, and costs for each approach.

Main Results:

• All four buprenorphine treatment approaches are projected to increase net practice revenues ($18,000-$70,000 per physician annually).
• Physician-led visits with nurse care managers and shared medical appointments yielded the highest net revenues ($29,000-$70,000 per physician).
• Maintaining at least 9 patients in treatment with a no-show rate below 34% is critical for positive net revenue.

Conclusions:

• Primary care practices can financially sustain buprenorphine-based OUD treatment under specific demand and no-show rate conditions.
• Nurse care manager-supported models appear to be the most financially sustainable approach for buprenorphine delivery.
• Simulation modeling provides valuable insights for practice leaders considering OUD treatment integration.