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Evaluation of healthy outcomes

June 19, 2009
by Rob Swindell
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Our nation’s healthcare system continues to struggle with the notion of being a “sick care” system. Though it is certainly not the intent, it is, nonetheless, a system in which doctors and pharmaceutical companies are financially rewarded when their patients remain sick.

Addiction gets it right in their commitment to measure successful outcomes—a system of evaluation based on the number clients that get healthy. The consideration of successful outcomes may include several factors, such as type of program, choice of drug, socio-economic status and personality. In addition, and in furtherance of successful outcomes, agencies attempt to analyze incidental data to discover what gives their clients their best chance at success (time of day, transportation issues, reducing waiting lists, etc.).

In the end, the agency records successful outcomes on the clinical side and units produced on the fiscal side. In regards to the latter, an agency will often evaluate counselors based on productivity numbers. I wonder if this measure, however, is consistent with the weight placed on successful outcomes by funders. It is sort of like rewarding a baseball pitcher based on the number of pitches he throws and the not the number of runs he gives up.

It might be a challenge considering the individuality of clients, but short of malpractice, and beyond education or licenses, certainly some counselors are better than others are. It might be about production, but assuming that, over time, counselors will get the same proportion of clients "capable" of successful treatment, then it can also be assumed that the rate of success can be calculated and compared.

Using this calculation, perhaps agencies could then consider putting more weight on evaluating addiction counselors based on their successful outcomes, those people that actually get healthy (or to the next stage of treatment), and not on “productivity” numbers as defined by billable hours. This would incentivize the focus of counselors to remain where it should be—on the client.

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Comments

An interesting concept, Rob, that I suspect not all counselors would agree with.

Rob Swindell

Rob Swindell

@robswindell

www.robswindell.com

Rob Swindell is the Associate Director of the Alcohol and Drug Addiction Services (ADAS) Board...