How Evidence-Based Drug Testing Saves Insurers Money in the Long-Run

Richmond, Va. – As health care costs continue to rise and America remains tightly in the grip of the opioid crisis, the health care industry is searching for ways to improve treatment and outcomes for those with substance use disorder while also lowering treatment costs. On average, individuals with substance use disorder cost the health care system six times more than those without.

Random drug testing at the appropriate frequency via an accredited lab is the first step toward a real, meaningful impact.

The intentional protocol of frequent, random drug testing is not only proven to help get people with substance use disorder into treatment and improve treatment results, it also saves health care expenses in the long-term. Individuals who do not develop preventable conditions related to substance use disorder will not cost the system tens of thousands of dollars per person per year. These preventable conditions include frequent ER visits, HIV, Hepatitis C and even Neonatal Abstinence Syndrome. These events can cost anywhere from $30,000 to $100,000 per person per occurrence.

Those per person costs related to substance use disorder add up into billions spent on health care per year. Would you be willing to invest more in best practice drug testing protocols to prevent health care conditions that are costing billions? Maybe the better question is: Why would you not be willing?

Costs and Cost Savings

The statistics are staggering. Nearly 21 million people in the U.S. have a substance use disorder, and our national substance abuse crisis impacts 1 in every 3 U.S. households. 

The costs are also staggering. Total U.S. spending for all those with mental health and substance use disorders is about $752 billion a year, about one-third of total health care spending which is $2.2 trillion.

Evidence-Based Drug Testing Save Insurers Money

Patients with mental health and substance use disorders are responsible for about 64% of total non-pharmacy medical costs for facility-based services, and in fact have the highest proportion of facility-based medical costs than any other group.

Medicaid is playing an increasingly important role as a payer of services for individuals with SUD in the United States. Nearly 12% of Medicaid beneficiaries over 18 have SUD. In addition, 15% of uninsured newly eligible individuals have SUD

In the Medicaid population, mental health and substance use disorder patients represent 20% of total Medicaid membership; yet they incur nearly half of the health care expenditures of this group for both inpatient spending and ER visits.

Specifically, Neonatal Abstinence Syndrome is a significant and rapidly growing public health concern directly related to the opioid crisis. The incidence of NAS in the United States increased nearly five-fold between 2000 and 2012, reaching a total of 21,732 infants diagnosed with NAS in that year. That is a rate of one infant born with NAS approximately every 25 minutes. More than 80% of infants treated for NAS have their care paid for by Medicaid.

Best-Practice Drug Testing Protocols

Laboratory screen drug testing, conducted by trained lab professionals using sophisticated lab equipment, detects over 1,500 substances—far more than instant screen tests. The biggest advantages of the laboratory screen: results are 99% accurate and can distinguish between new or residual elimination.

A unique advantage of laboratory screen testing is the ability to create a custom panel for each client, and the option to rotate the tests on that panel to cover more drugs. That means you can rotate and swap out the substances being tested for each client, in consideration of their individual history, behavior, and other factors, so they cannot fool the test. Laboratory screen testing is also compatible with most specimen types—including urine, oral fluid, hair, blood, and sweat—providing a wider range of testing options.

More good news: the laboratory screen’s threshold is lower than the instant screen at two to 400 ng/mL. There is established case law to support laboratory screen results, and laboratory screen results are defensible in court.

Laboratory screen costs range from $3 to $50 per test. While that is higher than some instant screen tests, with more accurate results you will save money in the short-term. This is because you will not need additional confirmation testing often required to verify a much-less-accurate instant screen. Long-term, improving treatment for substance use disorder means more individuals in recovery and a reduction in development of preventable conditions that are costing billions in health care treatment every year.

Health Care Reimbursement

As Medicaid reimbursement shifts from fee-for-service to pay-for-performance, better care and better outcomes become even more important. Higher recovery rates and lower rates of relapse are good for patients and translate into cost savings and more reimbursements. Bottom line: better outcomes are better for payers because they lead to improved health care cost controls and stronger overall financials.

A new model of integrated medical and behavioral health services also aims to control and impact health care costs, while at the same time impacting patient outcomes. Because individuals with substance use disorder typically receive fragmented care via ER visits, inpatient, outpatient and addiction treatment centers, it is difficult to deliver quality treatment. The goal of integrated medical and behavioral health is to create a comprehensive, coordinated care approach for substance use disorder patients — including medical and behavioral health services — and to provide them with the long-term, coordinated care they require for successful treatment outcomes.

On average, medical costs for patients with chronic medical conditions and mental health and substance use disorders are two to three times higher than costs for patients with only chronic conditions.

Additionally, an alternative payment model for integrated medical and behavioral health aims to financially incentivize providers, payers, and other stakeholders to treat patients with substance use disorders as if they had a chronic condition, using a similar “standards of excellence” model based on best practices. 

For reference, you can find the Milliman report online here.