The term “critical juncture” has long been used to describe the point in time in which monumental events, ideas, or decisions chart a new course, which is significantly different than the one previously traveled. At one time or another every nation, industry, company, or individual faces such a moment in their existence; often more than once.
The addiction treatment field is at its first critical juncture of the 21st century. The decisions being made today regarding clinical models, reimbursement constructs, and defining provider quality will determine how treatment services are provided for at least the next generation. Understanding how to recognize the opportunity in this crucial moment, and knowing what to do about it, is the difference between landing on the right side of history or the wrong.
Quantifying and truly grasping treatment efficacy is paramount for providers. How can we treat that which we do not understand? Gaining insight into treatment results and, subsequently, how to deliver evidenced-based clinical care and individualized treatment, is simply good healthcare.
As the clinical environment evolves and providers improve their curriculums, it is imperative that data-focused continuing care models are implemented. Ultimately, when clients leave treatment and return to their lives, a perspective on their outcomes is gained through the consistent collection and analysis of longitudinal data derived from the full spectrum of their experience.
How this data is looped back to formulate treatment plans and improve outcomes is a revolutionary conversation. Never before have providers had the ability to access such high-integrity, scientific data.
Clients and Their Loved Ones are Becoming Discerning Healthcare Consumers
With boundless information key strokes away, clients and their loved ones (read: healthcare coordinators) have become much more savvy. The providers who empirically demonstrate program efficacy and quality of care attract increasingly informed clients to their programs.
Quantified outcomes need to be a key component of a facility’s brand identity. This is a significant departure from an era in which clients and their care coordinators did not ask the tough questions, and into a new era where they ask questions and demand to know the answers. The clients who seek results-oriented programs are strong and will continue to grow as the ability to quantify outcomes becomes a required attribute of a ‘quality provider.’
Today, not enough providers recognize the emergence of this type of client. Therein lies one opportunity this critical juncture presents for treatment providers: quantify results, build an outcomes-driven identity, and appeal to a surging demographic of highly-informed clients.
Pay for Performance is Coming to Addiction Treatment
Across America two important groups are asking the same question: How will addiction treatment outcomes be tied to reimbursement? The first group, treatment center operators, is increasingly populated by a new breed of outcomes-focused and business-oriented executives resulting from ongoing acquisitions by private equity firms. These operators are keenly aware that insurance executives are asking the same question and are busy forming the constructs that answer it. We are on the precipice of performance-based reimbursement.
The first manifestations of this new reimbursement paradigm may come as early as this year. As insurance companies formulate and operationalize the pay for quality models, it will be increasingly difficult for providers to realize quality reimbursements without demonstrating some degree of value for the services they render. This different reality will place many insurance-dependent providers who are behind the outcomes curve in what may be an existential quandary.
The idea that provider performance would be tied to reimbursement is not a new concept, as successful models have existed in various areas of healthcare for decades. Medical specialties such as oncology and cardiology produce a great deal of empirical information from procedures such as cardiograms and c-scans that can definitively determine the efficacy of various treatment modalities. Quantifying outcomes presents fewer difficulties for these specialties.
Behavioral health, and specifically addiction treatment, has historically been more elusive and hampered by a lack of insight as to how to define and measure client success, and perhaps most importantly, how to keep clients actively engaged throughout the process in order to produce meaningful and complete data sets.
There has long existed a small contingent of far-sighted, but often ignored or dismissed, treatment professionals and industry thought leaders who have known for many years this juncture would arrive. These treatment professionals served the invaluable role of igniting a data conversation. Their thoughts and questions relating to data science, collection methodologies, and sample analyses—which were once overlooked—have come to now occupy the center of the field’s biggest conversation.
The Growing Need to Gather and Interpret Data
As a result of the addiction treatment field’s growing acceptance of outcomes, data-related services specifically designed for addiction treatment are beginning to appear in the marketplace. Provider organizations, trade shows, and non-profit organizations dedicated to addiction treatment have made the subject of outcomes a central theme in their focus.
Electronic Medical Record (EMR) developers are aware their products are more than electronic charts. They are actually valuable data repositories that store the baselines for critical client measures upon admission into treatment. As these tools and platforms materialize, providers must discern which are suited to support them as they transition into an evidence-based existence. The process will require providers to define an outcomes goal that takes clinical, operational, and future reimbursement factors into account.
Ultimately, provider data intended to support reimbursement will be required to fit standardizations set forth by insurance companies. For example, there is a strong belief among insurance executives that providers cannot collect data on themselves. According to these executives, the resulting positive bias and potential for manipulation within the data sets would be too great. Passively collected data, such as information clients submit at their leisure through a phone app, is unlikely to be considered scientific or sufficiently accurate to satisfy data quality standards currently contemplated by insurance companies.
Fortunately, the uncertainty caused by this transition is temporary. A clearer definition of the final form these reimbursement constructs and their supporting data requirements take will be discriminatingly determined. Empowered by the knowledge that the reimbursement landscape is changing, some providers have proactively reached out to insurance companies to gain a seat at the proverbial discussion table. It is essential to find the equilibrium in which patients receive quality care, providers are justly paid for its delivery, and insurance companies gain predictability. Nothing less is sustainable.
As the adage goes, “growth happens outside the comfort zone.” While the transition into this new healthcare paradigm may initially be uncomfortable for many providers, it will be the moment that propels the addiction treatment field into its finest hour. As we enter this critical juncture, the right side of history will belong to the providers who recognize the opportunity to quantify their efficacy, execute a plan, and embrace their new reality of quantifying treatment outcomes.
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