Applying quality measures to addiction has traditionally been challenging because of a lack of research data and the anonymous nature of the treatment programs themselves. But as private payers and federal and state agencies shift to a pay-for-performance model of reimbursement, the industry has begun developing new quality measures and standards.
Many states, especially those that adopted Medicaid expansion, have seen significant demand for addiction treatment services over the past five years, and the ability for patients and payers to better gauge the efficacy of providers is critical. There are existing efforts, such as SAMHSA guidelines, but more formal standards are emerging.
“You have to have very good indicators of what quality is and a way to know when you are actually getting it,” says Sarah Duffy, associate director for economics research at the National Institute on Drug Abuse (NIDA). “There is not a lot of research on that aspect of treatment in the SUD field.”
For patients, the array of providers can be confusing and deciphering which services they need and from whom can be guesswork.
“The truth is, most of them look at whether their insurance will cover the service or how much it costs, rather than looking at the clinical components,” says interventionist Karen Rainer, founder and president of Circle of Care Consultants in Florida. “You want to look at the clinical staff, what their experience is and what services they can actually provide.”
If I hear someone say they’ve been to a treatment facility two or three times, it’s time to re-evaluate their needs
Integrated and evidence-based
Quality addiction treatment should be integrated, patient-centered, evidence-based and outcomes-informed. According to Siobhan Morse, director of research and fidelity at Foundations Recovery Network, in order to adequately and accurately judge the quality of a program or intervention, patients and payers need to know its impact. Is it effective in achieving a predetermined goal, such as remission or long term recovery?
“This requires valid and reliable data collection processes, such as those that meet SAMHSA standards, use psychometrically sound data collection tools and methods, and represent a sufficient number in the treatment population as to be considered representative,” Morse says. “Outcome information is then used to support the quality management processes and to inform decisions at multiple levels: from programming decisions to management decisions.”
In the past several years, there have been multiple efforts to adopt comprehensive measures that can better gauge the quality of care.
SAMHSA’s National Behavioral Health Quality Framework (NBHQF) was developed to help examine and prioritize quality prevention, treatment, and recovery elements, and was developed as a “guiding document” for implementing quality measures in agency or system funding decisions.
Last year, the agency also launched a pilot test to integrate a recovery measure into existing grantee programs’ data collection efforts using an eight-item recovery instrument originally developed by the World Health Organization.
NIDA earlier this year launched its “Innovations in Measuring and Managing Addiction Treatment Quality” challenge, asking for public input on ideas for ways to measure quality that go beyond the data available in provider and payer systems. According to Duffy, the NIDA challenge is a way to look at the next generation of measures and to inform ongoing data collection efforts.
“What other entities are doing right is looking at the data systems as they are now,” Duffy says. “What we’re trying to do is get ahead of the curve and come up with research, so that when we have an opportunity to enhance the data system, we can have really innovative ways to measure quality that might be better at capturing the clinical effect.”
NIDA also hopes to find ways to make data collection easier for providers.
“We hope as we receive submissions for the challenge that people have thought through these issues,” Duffy says. “The criteria are comprehensive, and they have to think about the effects on workflow and how burdensome these processes are.”
Last November, the American Society of Addiction Medicine’s (ASAM) board approved a new set of performance measures for addiction specialist physicians developed through the organization’s Practice Improvement and Performance Measures Action Group (PIPMAG). With input from a wide array of stakeholders, ASAM released nine initial measures and recommendations on research that would help improve their use.
In March, ASAM released a full report on those performance measures. According to PIPMAG Chair Corey Waller, the group focused on measures related to treatment effectiveness.
“The truth of any measure is whether it equates with an outcome,” Waller says. “If it doesn’t help you to understand how it improves patient care, then it is a useless measure. We spent time making sure the measures we put in place, if those activities are followed, then health is improved and outcomes are improved.”
ASAM believes all of the standards and benchmarks are achievable, although reaching them will take time.