New Systems of Care for Substance Use Disorders: Treatment, Finance, and Technology Under Health Care Reform
Section snippets
Prevailing Systems of Addiction Treatment and Funding
Roughly 23.5 million American adults have a substance use disorder, but only 10.4% receive the addiction treatment they need.1, 2 Stated differently, 20.9 million persons, totaling 8.3% of the US population age 12 years or older, needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty substance abuse facility in the last year. Although most persons with addiction see a physician at least once every 2 years,3 it is most often for medical/surgical
Emerging Systems of Addiction Treatment and Funding
For the last decade, national quality agencies have recognized the need to transform the US health care system. Acknowledging inefficiencies in health care service delivery and deficiencies in overall health care quality, the Institute for Healthcare Improvement called for the simultaneous pursuit of 3 aims as part of a national vision to improve the US health care system: improving the experience of care, improving the health of populations, and reducing per-capita costs of health care.12
Implementing and Expanding Systems of Addiction Treatment: Case Studies
By now, it should be recognized that expansions in health insurance coverage and incentives to transform the delivery of services under health care reform, harbors the promise to develop a national system of care for the treatment of addiction that is both comprehensive and effective. Realizing this national promise, however, is fraught with uncertainty, arising from new regulations, financing, incentives and real-world implementation challenges, which all must be mastered to “put services on
Emerging Technology and Information Management in Addiction Treatment
Supporting all the aforementioned advances in clinical care are parallel advances in health information technology, expanded data collection systems, and the use of computer-based treatments. Adoption of these new technology-based systems and therapies are necessary as an effective and cost-efficient means to directly support the systemic change goals promoted by health care reform. When addiction treatment is driven by fully integrated electronic medical records; automated utilizing
Summary
This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase.18 Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage
Faculty Disclosure and Conflict of Interest
The following authors have identified no professional or financial affiliations for themselves or their spouse/partner: Eric Goplerud, PhD, MA, Judith Martin, MD
The following authors identified the following professional or financial affiliations for themselves or their spouse/partner:
David R. Pating, MD:
Appointee: California Mental Health Services Oversight and Accountability Commission (no compensation).
Michael M. Miller, MD:
Consultant/Advisor: National Academy of Sciences Committee on
Acknowledgments
The authors graciously acknowledge Constance Weisner, DrPH, MSW (Kaiser Permanente Division of Research) for her helpful comments and review of this paper.
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The effect of Medicaid expansion on state-level utilization of buprenorphine for opioid use disorder in the United States
2022, Drug and Alcohol DependenceUsing conjoint analysis to study health policy changes: An example from a cohort of persons who use drugs
2021, International Journal of Drug PolicyCitation Excerpt :Federal health reform through the Patient Protection and Affordable Care Act (ACA) of 2010 sought to improve population health and reduce the percentage of Americans lacking health insurance. Of relevance for PWUDs, the ACA included SUD treatment as an essential health benefit that must be included in all health insurance plans, including Medicaid, and also expanded parity in reimbursement for SUD treatment (Beronio, Glied, & Frank, 2014; Garfield & Druss, 2012; Pating, Miller, Goplerud, Martin, & Ziedonis, 2012). However, states still had discretion over which specific services were included within their Medicaid programs, resulting in some differences between states regarding coverage for specific levels of care and medications for opioid use disorder during the early phase of ACA implementation (Grogan et al., 2016).
Is it feasible to pay specialty substance use disorder treatment programs based on patient outcomes?
2020, Drug and Alcohol DependenceA pilot replication of QUIT, a randomized controlled trial of a brief intervention for reducing risky drug use, among Latino primary care patients
2017, Drug and Alcohol DependenceCitation Excerpt :Limitations of the study include: generalizability of the sample to other Latino populations, potential for social desirability bias to influence the primary outcome of self-reported drug use reduction which we tried to minimize by patients’ self-administration of survey items on a tablet computer, loss to follow-up, and small sample size which limits subgroup analysis. The U.S. Affordable Care Act (ACA) and the U.S. Mental Health Parity and Addiction Act (MHPAEA) expanded behavioral health coverage to 62 million people, who might benefit from brief intervention programs for risky drug use in primary care settings such as FQHCs (Buck, 2011; Pating et al., 2012). An effectiveness/implementation study of QUIT in FQHCs is needed to confirm its general applicability to fulfill this need.
Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems
2017, Journal of Substance Abuse Treatment