An Integrated Medication Treatment Program in Community Health Centers in California

A model for healthcare providers that serves low-income, complex patients with opioid use disorder with a focus on integrating medications for opioid use disorder and primary care as well as overcoming implementation barriers

The California Health Care Foundation (CHCF) started a pilot project in 2015 to lower the cost of care for patients with opioid use disorder (OUD) and improve outcomes as well as address other complex care needs in the primary care setting. Integrated models that included medications for opioid use disorder (MOUD) were developed with a focus on sustainability in community health center settings in California, and these were funded through the CHCF.

This initiative was designed to overcome barriers to implementing an integrated care model with buprenorphine prescribing, and included eight partnerships consisting of eight Medi-Cal plans and ten healthcare provider organizations, five of them federally qualified health centers and four county-funded providers. These challenges include identifying and engaging patients, integrating multiple disciplines with different cultures, navigating fragmented financial sources, and lack of evidence of cost-effectiveness of this type of initiative.

Researchers from the Urban Institute’s Health Policy Center performed an evaluation of the program with aims to assess program implementation and identify program goals, do preliminary measures of evaluation objectives, and explore the potential of measuring the program’s return on investment. 

There is tremendous opportunity to increase access to OUD treatment in outpatient primary care settings using buprenorphine and naltrexone as part of an integrated program.

Continuum of Care
Type of Evidence
Report with evaluation
Response Approach
Comprehensive services
Medications for Opioid Use Disorder

Evidence of Program Effectiveness

“The four CHCs that participated in the project were selected from the 10 health care provider organizations that participated in the initiative because they were furthest along in implementing their MAT programs or had the highest potential for accessing and analyzing patient encounter and cost data. All four CHCs offer a wide range of family practice, primary care, mental or behavioral health, counseling, and dental services. They serve different communities (urban, rural, and suburban with neighboring rural communities) and vary significantly in the number of patients they serve annually (ranging from 6,000 to over 150,000 patients). As of August 2017, MAT program enrollment across the four CHCs ranged from 18 to 210 patients…Primary care clinics are an important component of a comprehensive system of care for OUD. There is tremendous opportunity to increase access to OUD treatment in outpatient primary care settings using buprenorphine and naltrexone as part of an integrated MAT program. According to the California Health Care Foundation’s website, “integrated care” MAT programs are MAT programs “that “[knit] together […] mental health care and substance use disorder treatment with health care as a whole.” (Wishner et al., 2018)

"California has launched several statewide initiatives to expand MAT access, relying on primary care as one access point in a broader network. This initiative, which focused on four FQHCS, demonstrated that it takes time, funding, technical assistance, training, leadership, and effort to help CHCs provide integrated MAT care, but that such efforts can be successful and help expand access to treatment for OUD. We found that FQHCs face certain cost barriers to implementation of team-based integrated care MAT programs in Medi-Cal but also have some funding advantages that can help support team-based integrated care MAT programs, including specialized funding opportunities and experience covering case management costs through Medicaid prospective payment reimbursement rates. Although this project initially intended to test new reimbursement models, calculating program costs and determining changes in utilization proved to be too difficult for the participating CHCs and their health plans to implement, at least with available resources. Nevertheless, each health center found a way to cover the costs of the program through a variety of funding sources. To expand access to OUD treatment, some initial investments will likely be needed to help CHCs develop an integrated MAT program and adapt that program to their own systems, work processes, staffing, and patient populations. Medicaid officials and other policymakers could also explore ways to help ensure that CHCs and other primary care providers are able to obtain adequate reimbursement to provide the full set of services needed in a team-based integrated MAT program.” (Wishner et al., 2018)