Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform

Andrews, Christina M.; Abraham, Amanda J.; Grogan, Colleen M.; Pollack, Harold A.; Bersamira, Clifford; Humphreys, Keith; Friedmann, Peter D.

doi:10.1377/hlthaff.2014.1330

Cited by 88 publications

(47 citation statements)

References 23 publications

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“…315,325 In the US, realizing the promise of the Affordable Care Act (ACA) to expand health insurance coverage for drug dependence-related services for millions unable to afford them before ACA has been hampered by lack of human resources to expand care and lack of integration of these services with other federally qualified health services. 326 …”

Section: Treatment For Drug Dependence: the Need For Standardsmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Section: Treatment For Drug Dependence: the Need For Standardsmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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“…Currently, over a third of treatment programs still do not accept insurance of any kind (Andrews, Abraham, Grogan, et al., 2015) making the use of HEDIS measures (originally developed to be valid using claims data alone) difficult to apply to these settings. State agencies that oversee the funding and regulation of each state’s specialty addiction facilities have opportunities to help their state’s treatment programs qualify for insurance reimbursement and incentivize them to adopt adequate data collection and reporting systems to maintain licensing and accreditation (Buck, 2011).…”

Section: Discussionmentioning

confidence: 99%

Developing an opioid use disorder treatment cascade: A review of quality measures

Williams

Nunes

Bisaga

et al. 2018

Journal of Substance Abuse Treatment

123

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Background Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. Methods Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. Results Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. Conclusion Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.

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“…With the inclusion of tobacco cessation as a key preventive service in private and Medicaid health plans under the Affordable Care Act (88), SUD treatment programs have expanded opportunities to seek reimbursement for these services. However, the average treatment program currently receives very limited funding from these insurers (43), which may reflect both the lack of technology (e.g., electronic health records) as well as limited expertise related to billing insurers (89).…”

Section: Discussionmentioning

confidence: 99%