A New Era in Substance Abuse Treatment?

Of the 23.5 million Americans struggling with substance use disorders, 20.9 million, or 89.6 percent, do not receive the treatment they need, and the 10.4 percent who do receive care are subject to a system segregated from mainstream medicine. Primary care physicians rarely manage substance abuse disorders, unlike other chronic diseases; rather, patients are sent to niche systems and providers. The Affordable Care Act (ACA), provides an opportunity to improve quality of care for persons with these disorders by expanding coverage to medically disenfranchised populations and reforming care-delivery systems. The ACA links reimbursement to quality of care and mandates insurers provide equitable benefits for mental health and substance abuse treatment, thereby providing an opportunity to create a data-driven, technologically savvy substance abuse care delivery system that emphasizes prevention and integrated behavioral health.

In “New Systems of Care for Substance Use Disorders,” Pating et al. investigate how providers of substance abuse treatment can harness the ACA’s reforms to provide higher-quality care for patients by analyzing existing gaps in substance abuse treatment and providing feasible recommendations under the ACA. They illustrate the implications of the ACA on the substance abuse treatment community by examining three groups with substance use disorders: (1) those with unhealthy alcohol use who are not yet addicted, (2) nicotine users, and (3) opiate users. The researchers then analyze how the ACA can potentially improve care for these groups. They also explore the significance of technology and data-driven results implemented by the ACA and how the substance abuse treatment community can utilize these innovations to improve patient outcomes and cultivate best practice protocols.

Financial incentives emphasizing preventative care and counseling could radically improve outcomes for unhealthy, but not yet addicted, alcohol users, as well as chronic nicotine users. Research indicates that Screening and Brief Intervention (SBI) for patients with unhealthy alcohol use can lead to 20 percent reductions in binge drinking, 10 percent reductions in drinks per week, and a 20 percent reduction in emergency department visits. The research also indicates that every $1 spent on SBI in the primary care setting saves $4.30 in future health care costs . For chronic nicotine users, there already exists a body of literature regarding best practices for assessment and treatment. At present, there is still great need to coordinate and integrate best practices across medical settings. However, the ACA may catalyze this coordination, since the Centers for Medicare & Medicaid Services (CMS) now reimburse for nicotine addiction counseling and medication.

The emphasis on behavioral health service integration also has the potential to improve the quality of care for opiate users. Traditionally, patients receive medications, such as methadone, at sequestered Opiate Treatment Programs rather than at their physician’s office. Because this group of patients faces high comorbidity with other serious physical and psychological ailments, the researchers recommend that state and federal Medicaid and Medicare reimbursements allow for and encourage primary care physicians to integrate Opiate Treatment Programs into their practices, and vice versa. The authors are hopeful that the ACA’s commitment to equitable mental health benefits and medications will encourage this sort of innovation.

The ACA requires the use of health technology and data to improve patient outcomes. Electronic medical records have the potential to integrate substance abuse screening and assessment protocols into primary care, emergency, and inpatient hospital settings, as well as improve the continuity of care and reduce the duplication of services. There is also some support for technology-based treatments under the ACA, such as online substance abuse screening tools, social network-based peer recovery, and telepsychiatry. Finally, the ACA links hospital and physician reimbursement to measured effective outcomes, which will incentivize the substance abuse treatment community to develop data collection protocols and best practice materials.

The ACA’s commitment to mental health and substance abuse treatment has provided a platform for change. Professionals in substance abuse treatment are on the cusp of creating a new system of care for their patients. If the field can harness innovations in preventative and integrated care, technology, and data collection to improve quality, then an effective and holistic system of care for substance abuse disorders is within reach.

Feature Photo: cc/ (gongus)