The momentum of the Affordable Care Act (ACA) will continue regardless of legal challenges to the law or political moves to dismantle its provisions. Transformation of the healthcare industry is happening now, and it’s being driven by payers and providers on the front lines of care delivery, according to Michael Shafer, director of the Center for Applied Behavioral Health Policy at Arizona State University. He spoke at the Treatment Center Investment & Valuation Retreat in Scottsdale, Ariz., this week.
“Many of the macro systems of change in the healthcare system today cannot and will not be undone regardless of what happens,” he said.
According to Shafer, ACA’s key elements include reform in the following areas:
4. Payment; and
5. Health IT
What’s most important for behavioral health providers is to understand where the demand for services is increasing and why. For example, there has been a significant decline in uninsured rates for 18 to 34 year olds –which is the typical age range at which the symptoms of undiagnosed and untreated addiction and mental illness present themselves. Coverage in that population is a promising trend, he said.
Similarly, ACA demands that insurers cannot deny enrollment because of pre-existing health conditions. If someone is in recovery, they cannot be denied an insurance policy because of it nor can their care related to recovery be excluded from a policy.
Increasing coverage means increasing demand. However, the industry will struggle for some time to try and remedy the workforce shortages in behavioral health, Shafer said.
High quality is a must
With reforms looking to stretch the healthcare dollar, there is also a greater focus on quality, Shafer said. He recommends that every treatment center explore the concept of the Triple Aim, created by the Institute for Healthcare Improvement, which is often recognized in the healthcare system at large as a big-picture goal for the United States. Part of the Triple Aim is to deliver a better patient experience.
“How do you improve the experience of healthcare?” Shafer asked. “There’s an attrition rate of 60% or 70%. We bounce people out of treatment because they are not ready for treatment or they come in high. The modal number of treatment episodes in addiction treatment is one. Whatever we’re selling, the customer doesn’t like it.”
An emphasis on quality is sewn into various ACA provisions, and treatment centers will see increasing expectations for proof of value from all payers—not just commercial insurers. The key will be to gather data that demonstrates outcomes.
It might very well take 20 years before the provisions of ACA-era health reform are realized, just as the Medicare program has undergone years of refinement since it rolled out in 1965. Treatment centers of all sizes will see transformational changes on the ground in the years to come.