Addiction Programs Need Help to Maximize ACA Benefits

Megan Brooks

May 11, 2015

Addiction treatment centers need help to fully realize the Affordable Care Act's (ACA's) promise of improved access to high-quality addiction treatment, new research suggests.

The ACA "dramatically" expands health insurance for addiction treatment and provides "unprecedented" opportunities for service growth and delivery model reform, investigators led by Christina Andrews, PhD, MSW, assistant professor of social work, University of South Carolina, in Columbia, write.

"Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change."

"Coverage doesn't equal access," Dr Andrews told Medscape Medical News.

"We have about 30 million people that have new access to insurance coverage for addiction treatment, but we have a lot of addiction treatment programs that don't have the capability to serve those clients," she said.

These programs have a "real need for technical assistance around information technology as well as staff training," she said.

The study was published in the May issue of Health Affairs.

Falling Short

For the study, investigators examined how single state agencies from 49 states and the District of Columbia are helping addiction treatment programs respond to the new requirements under healthcare reform. The single state agencies are the state governmental organizations that oversee addiction treatment services.

The findings, they note, suggest that measures of support provided by these agencies "often fall short" of the likely need generated by healthcare reform.

Most agencies are providing some level of technical assistance to addiction treatment programs, but mostly in the form of helping programs develop collaborations with other health service programs.

Fewer than half are providing help in modernizing systems required to meet basic insurance company requirements, the authors found.

"Despite the resources that have come from the federal level to support states in implementing the ACA, this study really demonstrates that those funds haven't really made their way into the addiction treatment system," Dr Andrews said.

Only three states ― Idaho, Massachusetts, and New York ― are currently allocating state funds to facilitate ACA implementation within the addiction treatment system, the researchers report.

"More resources are needed around information technology and electronic health records that are really key. Medicaid is poised to become the dominant funder of addiction treatment as a result of the ACA, and Medicaid agencies need to play a bigger role in supporting these organizations to make these changes," Dr Andrews said.

There is also a need to provide education and training to increase the number of qualified addiction treatment counselors.

"Given the shortages of addiction treatment providers in many parts of the United States and the anticipated increases in demand associated with health reform, expanding the supply of counselors is especially important," the authors write.

Top Down, Bottom Up Approach

Petros Levounis, MD, vice chair of the American Psychiatric Association's Council on Addiction Psychiatry, agreed.

"In the long run, it is a very good idea to have professionally trained staff, because then you can bill the insurance, you can integrate treatment, and ultimately, you are doing patients a great favor because you are having professionally trained staff provide the treatment instead of people who might not be as qualified," Dr Levounis told Medscape Medical News.

He also agreed that coverage alone is not enough and thinks both a "top down and a bottom up approach" is needed to help addiction treatment systems.

"I think a top down approach from the government in terms of not only providing the funds, which we are delighted that they do, but also providing some guidance as to how to implement use of the funds," said Dr Levounis, who is also chair, Department of Psychiatry, Rutgers New Jersey Medical School, in Newark.

"But also we need to do our job from the ground up in terms of creating a culture where addiction treatment is considered to be as important and as deserving of professionally trained staff as any other part of medicine. We would not conceive having noncertified staff treat schizophrenia or depression, yet we find it perfectly acceptable to have nontrained staff treat alcoholism or drug abuse," he said.

The study was supported by the National Institute on Drug Abuse. The authors have disclosed no relevant financial relationships.

Health Aff. 2015;5:828-835. Abstract

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