Tuesday was one for the history books: After a year of contentious debate in Washington, President Obama signed into law a bill that virtually guarantees a sweeping overhaul of our healthcare system, including access to medical insurance for tens of millions of Americans.
No doubt, the changes will be profound. But, the question I and many others in the field have been pondering is, How will healthcare reform impact substance abuse treatment and the way we deliver care?
We know that in any given year, about 2.3 million Americans receive treatment in our substance abuse “specialty care” treatment system. However, according to the latest National Survey on Drug Use and Health, 25 million meet criteria for Substance Use Disorders (SUDs). One of the primary reasons why more than 90 percent of those who could benefit from treatment don’t receive it is that they lack insurance or other means to pay. Now that an estimated 95 percent of the country’s legal population will have healthcare coverage—and, thanks to the Wellstone/Domenici Parity Act, insurers who cover substance abuse treatment must do so at the same level of benefit they provide for other medical conditions—we’re likely to see a marked increase in the number of people seeking help. But insured patients want to make choices. So, how will our field adapt to meet their needs?
With parity and healthcare reform bringing substance abuse treatment into the realm of general medical care, one crucial priority is to develop partnerships with medical organizations. In the years to come, hospitals, doctor’s offices, and, in particular, Federally Qualified Health Centers will be the entrées to reaching new populations that we may never have been able to reach in the specialty care system. This will also give us the opportunity to deliver new services such as brief treatments, behavioral interventions, and, for those who need specialty care, to provide appropriate referrals.
These referrals are likely to include individuals who have drug or alcohol problems, but who are not acutely ill. Therefore, another priority for our field is the development of a workforce that can serve these new types of clients. Currently, clients come into treatment via an extensive intake process and enter a highly structured, abstinence-oriented program. These procedures may not be effective or tolerable for a client who is not severely dependent, a person who is not yet ready to become abstinent, or someone in recovery seeking support during a particularly stressful time. As we encounter clients with less severe drug use, we must have the capacity to deliver appropriate interventions—including Screening, Brief Intervention, and Referral to Treatment (SBIRT)—both on our own and through our medical partners.
In addition to developing the workforce to treat new clients and expanding our range of services, agencies will need an administrative staff that can process Medicaid and private insurance reimbursements for all treatment modalities. Currently, the majority of agencies do not bill Medicaid or private insurance. Smaller providers and those who do not have capacity to bill insurance may have to expand or partner with others who can perform this function.
These are just a few of the many adjustments we’ll need to make in order to maximize our potential in this era of change. But, while change isn’t easy, I have never been more optimistic about the future of our field. The Parity Act and healthcare reform bill reflect an understanding that addiction is a disease and that those struggling with this chronic condition deserve effective treatment as part of their regular healthcare. With greater access to the services we provide, we may eventually close the gap between the many men, women, and adolescents who need our help—and the few who receive it.Deni Carise, Ph.D. Chief Clinical Officer, Phoenix House Adjunct Clinical Professor, University of Pennsylvania Senior Scientist, Treatment Research Institute
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