New Systems of Care for Substance Use Disorders: Treatment, Finance, and Technology Under Health Care Reform

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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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