When the original American Society of Addiction Medicine (ASAM) standards were introduced in the 1980s, public discourse was dominated by the War on Drugs. Treatment funding was lagging, and the campaign's very name underscored the stigma and lack of understanding around addiction. Thankfully, perspectives have shifted over the years, with practitioners, clients, and policymakers recognizing the benefits of breaking down traditional barriers and evolving care to center on individuals' unique needs.  

Two recent developments are contributing to improvements in care management for Californians: the recent revision of the ASAM Criteria and a Medi-Cal benefit known as Enhanced Care Management (ECM).

We'll share what we know about these updates and how they improve outcomes in Whole-Person Substance Use Disorder (SUD) care.    

Why Were the ASAM Criteria Created? 

The ASAM criteria are widely accepted standards for the evidence-based treatment of individuals with substance use disorders. Before these guidelines were established, care teams often relied on arbitrary factors —such as prior treatment failures or fixed lengths of stay—when creating treatment plans. By contrast, the ASAM criteria have transformed modern care by enabling teams to: 

• Align clients, service providers, payers, and policymakers within a shared framework.
• Deliver a comprehensive "continuum of care" to meet clients' unique needs. 
• Provide client-centered, integrated treatment that supports long-term recovery.

What Prompted the Revised ASAM Criteria and the Development of Enhanced Care Management? 

The evolution of substance use disorder treatment has been shaped by time, research, and clinical insights. However, two key factors—an ongoing public health crisis and one piece of landmark legislation—played pivotal roles in developing the ASAM Criteria's 4th edition and introducing the Enhanced Care Management (ECM) program. 

The Opioid Crisis: Since 1999, the opioid epidemic has claimed over half a million lives in the United States. The arrival of synthetic opioids around 2013 added a new layer of complexity to an already devastating overdose crisis, making it clear that innovative approaches and updated treatment frameworks were urgently needed. 

The Mental Health Parity and Addiction Equity Act (MHPAEA): Enacted in 2008, this groundbreaking legislation mandates that mental health and substance use disorder benefits receive the same treatment as medical and surgical benefits regarding financial requirements, treatment limitations, and coverage caps. According to the Centers for Medicare & Medicaid Services (CMS), this act underscored the importance of integrating mental health care into SUD treatment, paving the way for more holistic and comprehensive care models.

ASAM Criteria Revised: 4th edition    

The Hazelden Betty Ford Foundation released the fourth edition of the ASAM Criteria in October 2023. These updated standards integrate the latest research and best practices in addiction treatment, emphasizing a chronic care model that promotes seamless care transitions and integrated services. The revisions also aim to make the criteria more accessible and practical for care providers by simplifying and clarifying existing guidelines.

New chapters were also added to keep pace with the evolving landscape of addiction treatment in an increasingly digital and complex world: 

• Early Intervention and Secondary Prevention
• Telehealth and Other Health Technologies 
• Integrating Recovery Support Services
• Integrating Trauma-Sensitive Practices, Culturally Humble Care, and Social Determinants of Health
• Addressing Pain
• Addressing Cognitive Impairment

By consistently implementing the 4th Edition criteria, care teams can deliver the right support, in the right amount, at the right time. These updates also reduce ambiguity around authorization requests, fostering greater clarity and efficiency in treatment planning. 

Enhanced Care Management and ASAM: Advancing Whole-Person SUD Care 

As all compassionate, competent care providers know, effective SUD treatment does not come in a one-size-fits-all approach. Whole-person care—a model that addresses a patient's physical, emotional, and social well-being—is the cornerstone of compassionate and competent care.    

Enhanced Care Management prioritizes compassion by assigning each eligible MediCal member a dedicated Lead Care Manager—a lifeline for members navigating the complexities of SUD treatment. ECM is a statewide Medi-Cal managed care plan (MCP) benefit launched in 2022 as part of the CalAIM program. It acknowledges the multitude of delivery systems needed to treat a SUD client successfully and supports a community-based, whole-person approach to care.   

In this Whole-Person SUD Care model, the Lead Care Manager meets clients in person, wherever they might be. The Manager provides personalized support and is a critical link between the member and other providers. By coordinating services and maintaining a holistic view of the client's needs, the Lead Care Manager ensures that no element of care is overlooked. 

As the ASAM continues to evolve and communicate best practice SUD treatment standards, California is raising its service delivery bar in kind. Leveraging the ASAM's 4th Edition criteria and ECM resources can help care teams achieve better-coordinated, integrated Whole-Person SUD Care. The result is the chance to help more individuals beat addiction and live healthier, fuller lives.   

Is Your Organization Ready to Deliver Whole-Person SUD Care?

Delivering Whole-Person SUD care goes beyond compliance. It requires integrating modern care standards, like the ASAM 4th Edition and Enhanced Care Management. To succeed, your team needs the right tools to streamline care coordination, improve patient outcomes, and stay ahead of California's evolving Medi-Cal requirements. Don't wait to elevate your care delivery—explore the latest solutions designed for Whole-Person Care today. 

At Exym, we're here to support your journey. For over 20 years, behavioral health agencies have trusted our intuitive EHR software to simplify billing, improve documentation, and empower providers to focus on what truly matters—delivering impactful, client-centered care. 

Ready to strengthen your ECM capabilities and elevate your SUD treatment outcomes? Book a demo today and see how Exym can help you lead the way in Whole-Person Care.