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NCAD attendees told to redefine their market

September 29, 2012
by Gary A. Enos, Contributing Editor
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Addiction treatment centers will fail to reap the many potential benefits of health reform unless they turn their attention to vast numbers of underserved individuals at severity levels well below their typical clients’, a leading clinical administrator said in the Sept. 29 opening plenary session of the National Conference on Addiction Disorders (NCAD).

And in the eyes of Deni Carise, PhD, chief clinical officer at Phoenix House Foundation, the estimated 20 million people who meet abuse or dependence criteria but don’t pursue care—and the larger group of 60 million who are simply harmful users of substances—don’t see much of value in traditional specialty addiction treatment programs.

“Frankly, they don’t want what we have to offer,” Carise said in the opening session of the conference in Orlando, Fla., a four-day meeting sponsored by the publisher of Addiction Professional and Behavioral Healthcare magazines. “I say that with the healthcare reform changes, we’re going to have to offer them something that they want.”

Carise, who has been at the forefront of a transformation of clinical care services in her position at the nation’s largest nonprofit addiction treatment organization, offered a striking scenario for anyone in the audience who doesn’t think their organization could or should reach individuals who do not meet abuse or dependence criteria. With research showing that moderate alcohol use can interfere with the effectiveness of drugs used to treat breast cancer, she said, couldn’t brief education in this area make a profound difference in the lives of many women with breast cancer who drink a glass of wine every night with dinner?

Carise was joined in the conference plenary address by Victor A. Capoccia, PhD, an internationally known consultant and a senior scientist with the addiction quality improvement collaborative NIATx. Capoccia discussed numerous favorable drivers toward improved success for treatment providers, including more sympathetic attitudes about treatment from policy-makers and the public in recent years.

In order for centers to capitalize, Capoccia said, they must make internal improvements (such as in rapid scheduling and seamless transitions to associated care providers) and establish an external presence (such as by making services available in general medical settings and by becoming part of accountable care organizations, as the Massachusetts-based organization SSTAR was able to do in part because it had taken steps to become a federally qualified health center).

Capoccia emphasized that remaining static isn’t a viable option for programs, many of which “often provide only one modality of treatment no matter what the client looks like.”

Much of the session’s discussion centered on profound effects expected from implementation of the Affordable Care Act (ACA), which Carise characterized as a significant step up from parity legislation because of its inclusion of substance use treatment as an essential service. With healthcare representing the largest chunk of the federal budget at 24% of the total, Carise tried to assure the audience that healthcare reform “won’t just go away” based on any impending political developments.

But both Carise and Capoccia said addiction treatment providers have a long way to go to be able to maximize the potential of this new era featuring millions more covered individuals. They each urged providers to build relationships with hospitals and physicians by conveying to them how they can solve their pressing problems, such as 30-day hospital readmissions of patients that are not reimbursable and often are caused by substance use.

Questions from the audience following the two presentations clearly showed unrest about several aspects of health reform, from wider implementation of electronic health records to a phasing out of substance abuse block grant funding at the federal level. An attendee from Texas remarked that if providers who are now highly dependent on the block grant end up transitioning to Medicaid reimbursement, they will encounter a state government that covers only about one-quarter of a program’s true costs in its Medicaid rates.

Another audience member asked about expected reimbursement for prevention services, and Carise suggested that addiction treatment organizations borrow the same terminologies that providers treating diabetes employ successfully to get paid for family counseling and other preventive assistance.