Kim Johnson and Todd Molefenter, deputy directors at NIATx, explain how creating provider-payer partnerships can improve addiction treatment.
Organization Overview
Founded in 2003, NIATx works with behavioral health and human services organizations across the country to improve the quality of services delivered by implementing a simple process improvement method. NIATx is part of the University of Wisconsin-Madison's Center for Health Enhancement Systems Studies (CHESS).
Bios
Ms. Johnson has an MS in counselor education and an MBA. Prior to coming to NIATx, she worked for the state of Maine as the director of the state substance abuse services office. She has been an agency executive director, program manager and child and family therapist.
Dr. Molfenter has a Ph.D. in Industrial Engineering. Prior to coming to NIATx, he worked for the Institute for Healthcare Improvement as the Director of Consulting services and was the quality director for a hospital system. Dr. Molfenter has twenty years of experience in organizational and system change.
Summary
Advancing Recovery, a NIATx project funded by the Robert Wood Johnson Foundation, was aimed at increasing the use of evidence-based practices (EBP) for addiction treatment through the creation of payer-provider partnerships. Providers learned process improvement and implementation strategies, and payers changed reimbursement structures, and addressed regulatory barriers to the adoption of EBP. Providers learned some basic tools, including a walk-through, putting themselves in the patient's shoes, and flow charting to identify where changes needed to be made to incorporate the practices they were interested in implementing. The payers used in this initiative were public payers, including state and county government entities.
Key Challenges
Many changes in the public system require legislative action or long public engagement processes in order to change a rule. The elongated timeline needed for this type of change requires the continued involvement of a champion over a long period of time. What may seem like a simple change on the surface, such as requiring contracted providers to accept patients on medications, could turn into a long drawn out process with a state legislator. We used coaching, over a three-year horizon, to support staff who were trying to make these changes.
Lesson Learned
You get what you pay for, and payers must think carefully about what it is they want to achieve. For example, one state changed contracts to mandate that every patient was assessed for the need for anti-craving medications. Three years after completion of the grant project, nearly 100% of patients are assessed for need for medication but there has only been a small increase in the number of patients who receive medication.
Coordination at the highest level of the payer organization is also absolutely necessary. In one county, a behavioral health organization participated in the project but the pharmacy entity did not, which caused gaps down the road.
Lastly, payer-provider partnerships work. Providers gave advice as to what payment strategies would be most effective. The payer-provider partnerships led to increased provider buy-in that, in return, facilitated smooth implementation of the new payment strategies and reduced political blowback on the bureaucrats implementing the changes.
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