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Preparing for major healthcare reform

June 1, 2009
by Ronald J. Hunsicker, DMin
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A look at the possible consequences for addiction treatment

Once President Barack Obama opened the door to the meeting of a very diverse group of stakeholders in the healthcare reform debate, information has been moving at a frenetic pace. Proposals, concept papers, plan designs, delivery system outlines, and so much more background information find its way into our in-boxes every morning. While everyone knows that it is much easier to have a photo op than it is to hammer out the details, the specifics are beginning to fall into place. There are some organizing principles that seem to have emerged as critical to any “detail development.” Some of these include:

  • Reducing healthcare's overall cost, including the cost of insurance (From a purely economic standpoint, we cannot sustain the healthcare cost increases we have seen during the past two decades)

  • Reducing the number of uninsured individuals, either through government or private insurance plans

  • Eliminating programs and procedures that do not measure up or provide the anticipated outcomes

  • Penalizing providers at every level for mistakes, inefficiencies, and unnecessary duplication

For those in the addiction treatment sector of healthcare, we are learning very fast that what is so very important, and perhaps sacred, to us is just a blip on the larger healthcare screen. But it is a blip, and it has been seen. We are finding that policy makers and other healthcare stakeholders recognize that addiction treatment has a role to play in healthcare and that this disease is intricately woven into the fabric of so many other diseases.

That is the good news. We have been heard. We have been recognized and if we present our case in a reasoned way, we will be taken seriously! The downside is that we may not fully understand or appreciate the impact that reform is going to have on the healthcare system and on our portion of the process.

Healthcare reform is going to be driven by research, evidence, information, outcomes, and cost efficiencies. None of these are new concepts to the addiction treatment field. Almost every conference and Web broadcast features these topics. The sticking point will be, To what extent are we able and ready to take these very concepts and translate them into practice?

As the temperatures rise throughout the summer, so will the level of the discussion about reform as details begin to take shape. While it is too early to know exactly where we will emerge, I would like to suggest that what we might see will be clustered around some of the following organizing points:

  • There will be more focus, and therefore more new dollars allocated, to determine what it will take to have an impact on the 19 million Americans not receiving any addiction treatment and yet meet the disease's diagnostic criteria.

  • Fewer dollars will be available for up-front stabilization services, and more dollars will be available for lifetime management of this disease (This will be driven by the understanding that addictions are a chronic disease).

  • Persons diagnosed with the disease of addiction will not be discharged but rather transferred within a delivery system. This will necessitate the need for developing delivery systems that span individual treatment organizations that focus on stabilization activities and not on those efforts needed to manage this disease over a lifetime.

  • The concept of alumni will have a diminishing meaning to individuals as they understand that the treatment of their disease transcends an organization.

  • Healthcare professionals at every level will be incorporated into addiction treatment.

When we wanted so desperately to be at the healthcare reform table, we may have wanted to protect our own interests. Yet true healthcare reform will take place only when those at the table are able to think and work beyond their own interests and ask what it will take to design, finance, and deliver the best healthcare to the entire population. As we move through the summer, we will see if this is possible.

Ronald J. Hunsicker, DMin, is President and CEO of the National Association of Addiction Treatment Providers. He is also a member of Behavioral Healthcare's Editorial Board.

To contact Dr. Hunsicker, e-mail


IN THIS DEPARTMENT Staff and members of the National Association of Addiction Treatment Providers share their insights. Behavioral Healthcare is NAATP's official publication.

Behavioral Healthcare 2009 June;29(6):43