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Certified Peer Support Specialists: Transforming traditional recovery for members

May 20 2019
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Following treatment for a behavioral health condition, ranging from inpatient levels to outpatient care, members often need encouragement in their recovery or assistance adjusting to a “new normal.” Having someone by their side who has lived that journey themselves – and can help promote a positive recovery – can help members understand the process, what to expect, and how to avoid and manage setbacks.

Traditionally found in Medicaid, Aetna is one of the first commercial insurers to cover peer support for members, an evidence-based behavioral health service that assists people with achieving long-term recovery from a psychiatric disorder or addiction. Over 70 percent of Aetna members that have been referred to peer support as part of Aetna Behavioral Health’s ongoing transformation initiatives have engaged with a specialist.

“Certified peer support specialists have first-hand knowledge of our members’ experience,” said Karen McBride, director, Network Management, Aetna Behavioral Health. “Their shared experience allows them to engage and connect with members, as well as their caregivers, to serve as an integral component of the treatment team.”

Aetna has also partnered with MAP Care Solutions (a provider of peer support services) to provide telephonic and video peer support to members for up to 12 months after they are discharged from treatment.

“Virtual peer support has enabled access for more members in addition to in-person specialists. Peer support has transformed the traditional process of recovery for members by ensuring treatment doesn’t stop the moment members transition to a new level of care,” said Malaika Vasiliadis, LMHC, implementation director, Behavioral Health Transformation, Aetna Behavioral Health.

Peer support can include talking to members, and to their family with a member’s permission, about the recovery process, sharing their knowledge to prevent a relapse and teaching practical recovery skills. In addition, peer support specialists can connect and accompany members to community resources to support their treatment, such as support groups, or even an auto mechanic, if the situation calls for it.

Recently, an Aetna member arrived home after being discharged from treatment to find his car wouldn’t start. Ryan Schweiger, the member’s peer support specialist, was fortunately by his side and able to support him through any negative recovery outcomes due to additional stress. Ryan had accompanied the member home and partnered with him to jump the battery and get the car to a mechanic for repairs.

“Small inconveniences like a dead car battery can be a huge stressor for someone who is in recovery for substance use disorder,” said Ryan, peer support team leader, Penn Foundation, a mental health and substance abuse treatment center in Pennsylvania. “They are vulnerable, and a situation like this can serve as a trigger.”

Aetna has empowered Ryan to do whatever is necessary to support recovery, and he is always ready to step in and help members. Beyond his impromptu trips to the mechanic, his work has ranged from jumping on the phone with members to remind them they are doing great, to attending recovery conferences together, to helping them find housing when needed and even organizing a trip to the barber to help them feel better about their appearance and connect them back to the community.

“As someone who has been through this, I know how difficult this can be.”

He notes though that each member journey is unique.

“Everyone has their own pathway; I don’t have the answers for my peers in recovery,” explains Ryan. “What worked for me won’t necessarily work for someone else. But I take my experience and help show them different pathways to recovery and provide explanations. Our job is to not judge, it is to support the person’s journey.”

As of April 1, 2019, there is no cost share* for Aetna members who utilize peer support. Aetna is continuing to expand its network of behavioral health and addiction facilities that provide certified peer support services to improve the length and quality of members’ recovery.

*Fully insured plans are waived. Self-insured plan sponsors have the option to exclude, and high-deductible health plan members must pay the deductible before cost share is waived.