At Beacon, recovery from substance use is not only possible—it’s expected. With more than 30 years of experience in managed care, we understand the unique challenges of addiction, and provide the right tools and resources to identify and treat substance use disorders and help individuals achieve and sustain long-term recovery.
Beacon’s proven model of substance use disorder care management relies on seven core features:
1. Development and Management of a High Quality Continuum of Care
We maintain a continuum of care to ensure members receive the right kind of support and setting for the fluctuating intensity of their needs. Our national network spans every state and encompasses all levels of care, so members can move to a less restrictive setting as soon as their condition improves while remaining in a safe and therapeutic environment.
2. Standardization of Screenings and Assessments
To help promote earlier engagement and improved outcomes for members, we use empirically validated screening tools to target substance use disorders when they are more manageable, and ensure these tools are readily available to providers in primary and community-based settings.
3. Endorsement of Uniform Medical Necessity Criteria
Beacon uses evidence-based medical necessity criteria, which guides decisions around service intensity, treatment setting, need for continuing care, and readiness for discharge. Our criteria is based on the ASAM Criteria, a collection of clinical guidelines developed by the American Society of Addiction Medicine (ASAM), the most widely used in the U.S. for the treatment of substance use issues.
4. Promotion and Adoption of Evidence-Based Services
To produce better outcomes for the treatment of substance use disorders, we promote systematic, evidence-based services developed by established experts in the field. These programs include:
- Medication-Assisted Treatment (MAT): Beacon promotes the use of supervised medication in combination with counseling and behavioral therapies to treat the whole person. Beacon’s approach includes real-time support for prescribers, such as an expert staffed support hotline for those treating substance use disorders.
- Structured Outpatient Addiction Program (SOAP): In Massachusetts, we incorporate SOAPs—short-term, structured, clinically intensive group-oriented treatment services—to individuals returning to the community from medically managed detoxification or acute treatment programs, or to individuals needing more intensive treatment than other outpatient programs may provide.
We also endorse programs supported by Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Programs and Practices, including:
- Matrix Model: Developed through 20 years of experience in real-world treatment settings, the Matrix Model is an intensive, 16-week outpatient treatment approach consisting of relapse-prevention groups, education groups, social-support groups, individual counseling, and urine and breath testing. The program includes education for loved ones affected by substance use disorders.
- Motivational Interviewing: We implement focused and goal-oriented Motivational Interviewing (MI) to help people recognize and change their high-risk behavior, and based on the individual’s goals, develop an action plan.
- Wellness Recovery Action Plan (WRAP): A self-management intervention, WRAP teaches participants how to implement the key concepts of recovery into their everyday lives, and helps them identify their personalized wellness resources in order to make an individualized plan to manage their disorder.
5. Easing the Administrative Burden
To help providers take the focus off of cumbersome administrative tasks and enhance member experience, we offer easy-to-use online assessments, medical necessity determinations, authorizations, and claiming at no cost to the provider. Our streamlined system makes routine tasks such as processing claims, obtaining claims information, and verifying eligibility status easy and convenient.
6. Support for Recovery through Peer Services and Long-Term Chronic Care Management
Beacon understands that treating substance use disorders is a continuous process—in fact, the National Institute on Drug Abuse (NIDA) reports that the relapse rate for drug addiction is 40 to 60 percent. Because we recognize the challenges associated with substance relapse, we offer long-term support for substance use disorders based on the principles of recovery and resiliency as we work to return people to their communities.
Beacon’s Peer Services offer members collaborative support through persons who have lived with substance use disorders and reached a significant level of recovery. Our trained Peer Support Specialists offer ongoing assistance and education as members reintegrate back into the community, helping members learn problem-solving skills and other strategies to help them achieve and sustain recovery. Peer Support Specialists can also help members identify and connect with community-based resources to support their unique ongoing needs.
Long-Term Chronic Care Management
Our chronic care management promotes the integration of physical and behavioral health services at every key stage of service, and improves overall integration and coordination of medical, behavioral, and psychosocial supports to help members transition back into the community. We work with medical case managers to ensure the development of culturally-specific, individualized care plans that reflect the member’s strengths and self- identified goals, and help members obtain services and connect them with community-based resources while advocating for the member’s needs, desires, and rights.
7. Continuous Outcome Based Program Improvement
We continually measure and improve our substance use disorder programs by using SAMHSA’s National Outcome Measures (NOMs) performance targets that measures real-life progress for members undergoing addiction treatment. Measurements includes targets such as abstinence from drugs, abstinence from alcohol, and member social connectedness. Beacon also uses health risk assessments, surveys, and call/outreach statistics to continually inform and improve the care management program.