How should addiction treatment programs be evaluated? That was the focus of the session, Quality Measurement In Addiction Treatment: Advancing Adoption Of Best Practices, at The 2019 OPEN MINDS Management Best Practices Institute, featuring Samantha Arsenault, MA, Vice President of National Treatment Quality Initiatives, Shatterproof; Eric Bailly, LPC, LADC, Business Solutions Director, Anthem, Inc.; and Doug Nemecek, M.D., MBA, Chief Medical Officer – Behavioral Health, Cigna.
Shatterproof, with a coalition of payers and other interested stakeholders, is taking on the challenge of quantifying the effectiveness of addiction treatment programs. Why? There is large variation in the use of evidence-based practices in addiction treatment programs and currently, provider organizations don’t have a standardized research tool to assess and benchmark themselves. Consequently, individuals don’t have reliable or unbiased sources to identify addiction treatment options.
To address these issues, Shatterproof is creating ATLAS (Addiction Treatment Locator, Analysis, and Standards Tool) an online tool available to the public, provider organizations, and payers to identify high quality addiction treatment provider organizations. (For more on ATLAS see, Are You Ready For The Shatterproof Addiction Treatment ATLAS?) This initiative will take addiction treatment program evaluation beyond its current state through claims data and data provided by the treatment facility and patient experience surveys in order to present a more complete picture of treatment program effectiveness.
Both Cigna and Anthem are moving toward value-based reimbursement for addiction treatment and both are using claims data as the initial framework. The collaboration with Shatterproof will likely add to the data available for the evaluation of the cost and effectiveness of treatment – and this will improve the VBR models.
Mr. Bailly explained that Anthem’s value-based initiatives for substance use disorder (SUD) treatment are influenced by the work of The Alliance for Addiction Payment Reform (Alliance), and have helped to shape Anthem’s SUD strategy outlined in three pillars focused on improving access to high quality SUD treatment services which are efficient and cost effective, and lead to improved health outcomes. Anthem has successfully launched value-based incentives with numerous provider organizations across the country, and is currently developing Addiction Recovery Medical Home Alternative Payment Model proof of concept pilots in several markets, with a goal to launch one of these pilots by the end of 2019.
Dr. Nemecek presented Cigna’s behavioral health network strategy – a strategy that also includes value-based reimbursement elements. The network strategy includes improving access to care through virtual solutions and network growth, promotion of affordability and quality, integration via accountable care organization support, creating provider organizations of choice with differentiated service models, and preferred provider organization network alignment.
To promote affordability and quality, Cigna has already begun selecting Centers of Excellence (COEs) for addiction treatment. The network currently consists of 302 behavioral health provider programs – 133 inpatient and residential facilities and 169 partial hospitalization/intensive outpatient programs. These programs were found to have lower costs for admissions and per customer than both other in-network provider organizations and out-of-network provider organizations. Readmission rates at COEs were also 24% lower than other in-network provider organizations and 87% lower than out-of-network provider organizations.
The collaboration of 21 health and human service stakeholders with Shatterproof on standardizing performance measurement is a significant step forward in creating an improved national approach to addiction treatment program evaluation. For more on the state of metrics-based performance evaluation, join us at The 2019 Technology & Informatics Institute in Philadelphia on October 29 for the session, Data Makes The Difference: Using Data To Manage Care Coordination & Value-Based Arrangements featuring Ken Carr, Senior Associate, OPEN MINDS.