May 30, 2024

Los Angeles County, California launched an initiative called “Reaching the 95%” (R95) to reduce barriers to county-funded addiction treatment with the broad goal of increasing the percentage of people accessing treatment from the current 5% to 95%. A key strategy is implementing harm-reduction strategies. It involves payment reform and financial incentives to provider organizations that meet the R95 requirements. The initiative started in 2023, as of late March 2024, about half of addiction treatment provider organizations that contract with the county were on track to become “R95 Champions.” 

R95 is overseen by the county’s Department of Public Health Division of Substance Abuse Prevention and Control (SAPC). Under R95, there are six incentive options in two focus areas that provider organizations can participate in. They earn the incentives by meeting specified benchmarks and activity-related deliverables. The first focus area is for outreach and engagement. The second is for establishing low-barrier care. 

The outreach and engagement strategies are focused on the following activities: 

• Expanding field- and street-based services to provide services for people who are not interested or able to receive services in other settings. 

• Increasing efforts to interface with other areas of health and social systems to better engage individuals who would benefit from addiction care in those systems. 

• Expanding low barrier (and low judgement) services such as harm reduction to better engage people who may not be interested in treatment but may still be interested in evidence-based services that can improve their health. 

• Expanding offerings of medications for addiction treatment (MAT) to reduce withdrawal symptoms and/or cravings. 

• Optimizing utilization of a new state policy that allows for outreach services to be reimbursable under Medi-Cal for people with potential substance use conditions. 

To reduce barriers to treatment, the R95 participating provider organizations cannot require people to be totally abstinent prior to admission. The programs are encouraged to partner with harm reduction programs, such as syringe exchanges, and to support bidirectional referrals between harm reduction and treatment. People in treatment who have a relapse cannot be automatically discharged from the treatment program.