This editorial appears in the addictions issue of National Council Magazine.
By: Becky Vaughn , Vice President of Addictions, National Council of Behavioral Health
Addictions providers in the United States face an odd duality: we are simultaneously needed and threatened.
Deaths by overdose have more than doubled in the past 15 years. There are now more deaths from overdose than from car crashes in the U.S.1,2 … and one-third of fatal car crashes involves a driver under the influence of alcohol and/or other drugs. Opioid prescriptions for chronic pain are leading to disproportionately higher use (and misuse) of opioids by military combat veterans.
Despite these trends, we continue to use a system that emphasizes punitive rather than restorative possibilities for people with addictions. According to the Federal Bureau of Prisons, 48.6 percent of inmates in the U.S. are in prison for drug-related offenses. As Paul Samuels, with the Legal Action Center notes in Roadblocks to Recovery on page 70, people who have been involved with the justice system face discrimination and challenges in accessing services and securing the same rights as others.
This approach is expensive. At the turn of the millennium, addictions were estimated to cost society more than $435 billion each year.3 That figure – which takes into account the costs associated with crime and car crashes in addition to child welfare, health care costs and loss productivity – has now ballooned to more than $710 billion.4 Yet, for those who received addiction treatment, the likelihood of being arrested decreased 16 percent and the likelihood of felony conviction dropped by 34 percent.
Anyone who provides addiction services knows that rapid change is the basis for all operating and planning decisions in today’s world.
In the past few years, addictions care has seen an enormous transformation in all aspects of operations and practices. The Mental Health Parity and Addictions Equity Act got the attention of insurers, who now must offer coverage for our services. But we still have a long way to go in full implementation and communicating the value of our services to insurers. We must continue our advocacy to ensure that coverage is truly established and that regulations are enforced.
A recent study in Health Affairs pointed out that “no other health care sector will be more deeply affected by the [Affordable Care Act] than the nation’s addiction treatment system. Major changes will occur in the structure of the addiction treatment services supplied and in the amount consumers’ demand. [The ACA’s financial] incentives are likely to prompt many existing programs of health and mental health services to expand their services to include addiction treatment.”
As I speak with providers across the U.S., chief among their concerns is establishing a solid sustainability plan. The transition of moving from federal and state funding to reimbursement from commercial insurance or Medicaid is daunting. New business practices, not needed in the past, are now required to be part of this new market. Billing systems, electronic health records, marketing plans and contract negotiations are major changes to an already underfunded system. Demands for a highly skilled workforce keep CEOs up at night wondering how to make that happen.
The same Health Affairs study noted that “most Single State Agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach.” Without technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA’s promise to improve access to and quality of addiction treatment.
First, we need to actively work toward sustainability of our sector—namely the practices that we know work in prevention and treatment no matter where they are delivered. More than ever, we need to strengthen relationships with community partners and branch out to establish contracts with new payers. We are stronger together. This can be done with mergers and acquisitions, but also with legally established networks of providers. Bigger is better when it comes to the economy of scale needed to put these new business practices into place. Broadening the scope of our services makes us more valuable to the community as well as to payers.
SAMHSA continues to put significant resources into initiatives to increase capacity to meet the new demand for services. The National Council is honored to run SAMHSA’s BHbusiness Plus program, an initiative to strengthen the business operations of organizations who provide mental and substance use disorder services – from new business planning to updating billing systems and accurately determining the cost of services. I’m pleased that so many providers are taking advantage of this free technical assistance and have been impressed with their results. I hope many more will learn and grow as a result of participation. Look at page 8 for more information on how BHbusiness is helping other organizations and how you can take advantage of this incredible resource.
Second, it is up to us (service providers and provider associations) to shape our destiny in the new landscape.
Health reform means service providers must be fearless and ready to take on the challenge. Are you? Take inventory of your service delivery environment: Are you maximizing primary care coordination? Do you have a health IT system and outcome measurement process in place? Are you efficiently coordinating resources with local, state and federal sources?
We should partner with our state offices and encourage them to be part of the needed changes, but we should not wait or be dependent on their help. We are the drivers in this new environment. We know what works clinically and we’re learning how to run businesses that provide health care services.
In July, the Centers for Medicare and Medicaid Services (CMS) issued a letter to state Medicaid directors outlining new service delivery opportunities for individuals with substance use disorders (SUDs). The letter clearly establishes SUDs as a primary, chronic disease requiring long-term treatment to achieve recovery. It also recognizes the need for a full continuum of care. States must take part in system- and practice-level reforms to meet the goals of the 1115 waiver opportunity, including enhancing clinical practices to include medications, recovery support, coordination with primary care and increased use of outcome measures, health IT and strategies to address prescription abuse and opioid addiction. This is the support we’ve been asking for and now we must now be ready to take advantage of their commitment to pay for what we, as a field, already know is needed. Other payers will follow their lead.
Capitol Hill and many state houses are buzzing with legislation in an attempt to “fix” this latest drug problem. We must be there to ensure that policies and funding are put in place to increase prevention, ensure increased quality and capacity for treatment and reinforce recovery. It will take our collective voices to stop misguided efforts that only focus on supply reduction and criminalization. Communities will need to put in place plans to include all aspects of prevention, treatment and recovery support — including supportive housing options. The National Council is proud to work with so many other national organizations, many of which are also active in the Coalition for Whole Health, who share the same laser focus on this issue. We celebrate the many efforts to support recovery, such as the October 2015 UNITE to Face Addiction rally.
Finally, we must learn from one another. There are some amazing agency transformations going on across the country. This magazine includes many examples of providers who are taking innovative steps to keep our field competitive, clinically excellent and strong. Together, we are finding ways to use our dedicated workforce to its fullest – from engaging primary care and strategies for early identification to expanding the roles of recovery support specialists in helping individuals and families meet their recovery goals. Together, we are shaping new best practices for prevention and treatment based in science and incorporating the latest technology to offer our services effectively and efficiently.
This magazine highlights some important pieces of the puzzle, but I know there are many more of you are doing outstanding work. I look forward to hearing from you and working together as we navigate change and explore new possibilities to grow the capacity for quality services.