Implementing the ASAM Criteria in Utilization Review and Management

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Implementing The ASAM Criteria in Utilization Review and Management

Course Overview 

Welcome to Using The ASAM Criteria in Utilization Review and Management online course designed to help managed care payers develop a holistic understanding of The ASAM Criteria and their role in constructing a full range of services for patients with substance use disorders (SUD). Through interactive and case-based activities, the course covers the process of conducting objective clinical case reviews, evaluating treatment plans, and determining the appropriate level of care in accordance with The ASAM Criteria. The course also explores the importance of implementing a collaborative process between treatment providers and payers to ensure patient-centered care. Participants will explore the payer’s role in anticipating and adapting to implementation challenges to meet patient needs

Begin the course by reviewing the Getting Started page that contains information about the structure and sequence of the course. From there, you can review the course introduction, faculty information, content modules, and different sections of the course to get acquainted with course navigation.

Quick Links 


ACGME Competencies

  • Patient Care and Procedural Skills
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Systems Based Practice

Target Audience

  • Managed-care medical directors
  • Licensed health professionals conducting medical necessity reviews for SUDs
  • Providers of SUD treatment 

Getting Started


Structure of the Course

It's important to familiarize yourself with the overall structure and elements of the environment in which you will be learning. This online course is fully online and self-paced. The course content, learning activities, and assessments in the course should be completed asynchronously—you will log into the course site and complete them at your own pace. The course will take approximately 8-10 hours to complete.

All content modules are available under the Course Content tab in the course navigation.

Module Structure

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Module Introduction

This section provides an introduction to the module and serves as a preview of what will be included.

 
 
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Module Learning Objectives

This section lets you know what understandings and skills are the focus of the module.

 
 
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Module Content

This section contains content and learning materials you need to read or view.

 
 
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Application Exercise

This section contains an interactive scenario or learning activity to help you apply the concepts.

 
 
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Module Conclusion

The section provides a summary of the module and a transition to the following module.

 
 
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Knowledge Check

Each module contains a short assessment and at the end of the course, you will take a post-test.

Course Introduction


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Implementing The ASAM Criteria in Utilization Review and Management

As increasing numbers of managed care companies, utilization management entities, and providers of care use The ASAM Criteria to guide level of care decisions, the opportunity for differences in interpretation and implementation also increases. Therefore, it is increasingly incumbent on all parties (clinicians, provider organizations, care managers, and payers) to manage care with clinical and fiscal integrity, in accordance with The ASAM Criteria. This course is designed to to help managed care payers develop a holistic understanding of The ASAM Criteria and their role in constructing a full range of services for patients with substance use disorders (SUD).

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Learning Objectives

At the end of this course, you will be able to:

  • Examine the guiding principles of The ASAM Criteria and the payer’s role in its system-wide implementation.
  • Evaluate patient risk ratings across the six dimensions, as defined in The ASAM Criteria.
  • Evaluate treatment plans and clinical assessments in accordance with The ASAM Criteria to determine if the requested level of care is appropriate.
  • Conduct objective, comprehensive clinical case reviews (and re-reviews) based on The ASAM Criteria to drive ongoing evidence-based care.
  • Implement a collaborative process between treatment providers and payers using common terminology of The ASAM Criteria to ensure patient-centered care.
  • Examine implementation challenges and develop strategies to provide appropriate treatment for patients with substance use disorders.

Faculty


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Dr. Alvin D. Pelt, MD, FASAM

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Dr. Alvin Pelt, MD, is an addiction psychiatrist in the Central Ohio area, where he began his practice in 1989. He is a graduate of Western Michigan University and Wayne State University School of Medicine. Dr. Pelt is Board Certified with the American Board of Neurology and Psychiatry, with additional certification in Addiction Psychiatry; he is also a Diplomate of the American board of Addiction Medicine (ABAM).

Dr. Pelt has over twenty years of experience in treating addictions; with specialization in the areas of alcohol and opiate addiction-recovery. He is currently the Behavioral Health Medical Director for Buckeye Health Plan, a Centene corporation affiliate. He has previously served as Medical Director for several addiction treatment programs in Central Ohio.



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Dr. Alvin Pelt Intro Video






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Dr. Wendy Welch, MD, FASAM

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Dr. Wendy Welch is a board-certified addiction psychiatrist. Her clinical career has been in treating both adults and children with addiction and co-occurring psychiatric illnesses. She is currently the Chief Medical Officer of Cardinal Innovations Healthcare, a specialty behavioral health plan that serves Medicaid recipients in about 20 counties across the state of North Carolina.

With 24 years of experience, Welch is a Certified Physician Executive and is also certified in Health Care Quality and Management. Welch received her Doctor of Medicine (MD) degree from the University of Florida in 1990. In 2019, Welch received an MBA in Business Administration, Management and Operations from the University of Massachusetts, Amherst.



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Dr. Wendy Welch Intro Video

Key:

Complete
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Course Overview
Course Overview
Begin self-paced component package.
Begin self-paced component package.
Module 1 Using The ASAM Criteria in Utilization Management
Module 1
Begin self-paced component package.
Begin self-paced component package.
Module 2 Conducting Initial Case Reviews
Module 2
Begin self-paced component package.
Begin self-paced component package.
Module 3 Individual Treatment Plan (ITP)
Module 3
Begin self-paced component package.
Begin self-paced component package.
Module 4 Continued Service and Transfer/Discharge Criteria
Module 4
Begin self-paced component package.
Begin self-paced component package.
Module 5 Becoming Proficient in Utilization Management Using The ASAM Criteria
Module 5
Begin self-paced component package.
Begin self-paced component package.
Evaluation, Post-Test, and Certificate
Post Course Evaluation
18 Questions
Claim Certificate
Up to 8.00 medical credits available  |  Certificate available
Up to 8.00 medical credits available  |  Certificate available

How to Claim Credits


To claim continuing education (CE) and/or continuing medical education (CME) credit, follow the steps below.

STEP 1

Complete all the content modules in the course located under "Course Content (5)." Each module contains instructional materials, interactive exercises, and knowledge checks. After completing the five modules, take the end of the course assessment.

STEP 2

Complete the post-course evaluation. Fill out the survey by clicking the blue "Fill out Survey" button. Be sure to scroll down on all Likert Scale questions. There are answers that expand past the size of the survey window. Submit the evaluation (the next box should activate, and the evaluation box should turn green with a white check mark).

STEP 3

Click the button “Claim Credits” in the box titled "Download Course Certificate." Choose the type of credit (Physician or Non-physician) and click submit. Click the button “View/Print Certificate” to save or print your certificate. If you ever lose your certificate, you can come back to the ASAM e-Learning Center and view it on your transcript (found in the Dashboard).

Credits and Disclosures


ACCME Accreditation Statement:

The American Society of Addiction Medicine (ASAM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The American Society of Addiction Medicine designates this enduring activity for a maximum of 8 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

In accordance with the disclosure policies of ASAM and the ACCME, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all educational activities. These policies include resolving all conflicts of interest between the CME Committee, Planning Committee and faculty, and commercial interests that might otherwise compromise the goal and educational integrity of this activity. All CME Committee, Planning Committee and faculty participating in the activity have disclosed all relevant financial relationships with commercial interests. The CME Committee has reviewed these disclosures and determined that the planning committee and faculty relationships are not inappropriate in the content of their respective presentations and are not inconsistent with the educational goals and integrity of the activity. 

NAADAC: 

This activity has been approved by the American Society of Addiction Medicine, as a NAADAC Approved Education Provider, for educational credits. NAADAC Provider #295, ASAM is responsible for all aspects of the programming. 

ASAM CME Committee

Name Commercial Interest Compensation Role
Catherine R. Friedman, MD, DFASAM None NA NA
Noel Ilogu, MD, MRCP, FASAM None NA NA
Herbert Malinoff, MD, FACP, DFASAM None NA NA
Edwin A. Salsitz, MD, DFASAM None NA NA
R. Jeffrey Goldsmith, MD, DLFAPA, DFASAM None NA NA
Adam J. Gordon, MD, MPH, FACP, DFASAM None NA NA
Zwaantje Hamming, FNP-C, CARN-AP None NA NA

Program Planning Committee

Name Commercial Interest Compensation Role
Corey Waller, MD, MS, DFASAM, FACEP, Chair None NA NA
David Mee-Lee, MD, FASAM None NA NA
David R. Gastfriend, MD, DFASAM
None NA NA
Lewis Breitner, PhD, LADC, LMFT
None NA NA
Amy Davis, DO, MS, FACP, FAAHPM
None NA NA
Jennifer Harrison, PhD, LMSW, CAADC
None NA NA
Melissa Holland, MA, MD, FACOG, CAADC
None NA NA
Christine Mulford, RN, MSN, FNP-BC
None NA NA
Surita Rao, MBBS, FASAM
None NA NA
Gerald D. Shulman, MA, MAC, FACATA
None NA NA

ASAM Criteria Education Committee Consultants

Name Commercial Interest Compensation Role
David Mee-Lee, MD, FASAM 1. Change Companies
2. Train for Change
1. Royalties
2. Training fees
1. Developing and delivering eTraining modules and Interactive Journals on ASAM Criteria
2. Training workshops on ASAM Criteria
David R. Gastfriend, MD, DFASAM 1. ASAM
2. Alkermes
3. Intent Solutions
4. DynamiCare Health BiorCorRx, FEi Systems, Horizon BCBS, IBM Watson
1. Royalty
2. Stockholder
3. Stock
4. Stock, salary
5. Fee
1. Chief Architect (Agent) CONTINUUM
2. Stockholder
3. Consultant
4. Chief Medical Officer & Co-Founder
5. Consultant

Faculty

Name Commercial Interest Compensation Role





ASAM CME Committee Reviewers

Name Commercial Interest Compensation Role
Adam Gordon, MD, MPH, FACP, CMRO, DFASAM None NA NA
Herbert Malinoff, MD, FACP, DFASAM None NA NA

Refunds, Cancellations and ADA Accommodations

All  refund requests and cancellations must be made in writing and emailed to ASAM's Education Department: education@asam.org

If you require ADA Accommodations, please contact ASAM's Education Department.

Fees


ASAM Member, Retired, Early Career Physician: $149.00

ASAM Member, Retired, Early Career Physician: $149.00

ASAM Resident, Student, Associate Members: $99.00