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Providers report limited capacity to succeed in changing business environment

May 13, 2014
by Gary A. Enos, Contributing Editor
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While it should come as no surprise that many addiction and mental health treatment providers report limited readiness to flourish in a new healthcare business environment, the across-the-board nature of the latest findings in an Advocates for Human Potential (AHP) survey offer cause for alarm.

Among the findings released last month from the Readiness and Capabilities Assessment (RCA) survey, it was noted that larger provider entities were not necessarily less vulnerable than smaller providers in the evolving healthcare marketplace. In addition, providers in states that have chosen to expand Medicaid coverage under the Affordable Care Act (ACA) barely outperformed the national average, and those are the providers that likely will face the sharpest increase in demand for mental health and substance use services.

“A lot of providers are still stuck in the mindset of being overwhelmed, being the deer in the headlights,” says AHP president and CEO Neal Shifman.

And AHP leaders are not buying the notion that providers are reporting limited readiness for the future because of uncertainties over what that future exactly entails. “I think we know a lot more about how an organization is going to succeed,” says Shifman.

AHP is a consulting and research firm specializing in healthcare and behavioral health topics.

Survey results

The RCA measures providers' capabilities in a number of core areas that are pivotal to business success in an increasingly complex healthcare environment. It has been evaluating the areas of general management; marketing; information technology and data management; clinical competencies and practices; and finance and revenue management. AHP recently added three core competencies that reflect current healthcare trends: patient-centered practices and capabilities; care integration practices; and human resources and people management practices.

The survey sample is extensive in that it incorporates providers identified by each state's single state authority (SSA) for substance abuse services, as well as providers that are part of a membership/trade association. AHP also has intensified its effort to add more mental health providers to its sample, broadening the survey beyond its roots in the substance abuse end of the field. Forty-two states and just under 1,000 respondents have been covered in the ongoing survey so far.

Respondents rate their organization's capabilities in each core area on a 0-to-4 scale, with 0 representing “not at all” and 4 denoting “to a very great extent.” Average scores in most categories in the latest released data were under 3, and in some cases were under 2. For example, providers scored an average of just 1.7 in the area of market development, encompassing factors such as identifying new markets and payer sources and understanding partnership opportunities in emerging structures such as health homes.

“Thriving in the future will be dependent on getting market share,” says Shifman. “If you're not marketing yourself, if they don't know that you exist, how are you going to compete?”

At least 50% of respondents report the need for technical assistance in each of the five original core capability areas except for general management. Moreover, while 54% of providers in states that are not expanding Medicaid report limited ability to adapt to ongoing changes, 47% of providers in Medicaid expansion states offer the same self-assessment as well.

Shifman adds that while both mental health and addiction treatment agencies report somewhat limited readiness to excel in the new environment, mental health providers have shown more of an ability to diversify revenue. He attributes the addiction treatment community's relatively lagging performance as indicative of what he calls the “risk-aversive nature” of the substance abuse treatment field.

Taking action

Jeff Zornitsky, AHP's director of strategic initiatives, says providers have been exploring and taking numerous actions as a result of the survey's findings and message. Applications of the results include:

  • Developing strategic plans and examining process re-engineering efforts in their organizations.
  • Assessing the market for the potential of targeted improvements, in areas such as starting to work with insurers under the insurance exchanges.
  • Initiating a process of rapid-cycle change management.
  • Engaging other providers in the process of creating networks.
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