Massachusetts Substance Use Disorder Treatment Organizations’ Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design

Abstract

The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations’ responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in-person June–December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms.

How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study

“…32 Behavioral health providers have struggled with attempting to modernize their workforce and business practices and have received limited TA in some states to address these struggles since reforms resulting from the passage of the ACA 33 A study among Massachusetts SUD treatment organizations found that providers faced similar challenges as they were responding to ACA reforms in terms of expansion of services and clinical practices, workforce development, and IT infrastructure. 34 This highlights that significant support to providers is needed to improve the SUD treatment system as well as more research to understand barriers and facilitators to making system-level quality improvements.…”

“…[9][10][11][12] Implementing quality improvement (QI) programs and expanding the use of technology will become essential to monitoring quality metrics and improving outcomes. 9,13,14 Developing partnerships with larger healthcare systems and other support services (eg, housing) may also be necessary to ensure all client needs are addressed. 9,14 VBP arrangements, as well as the clinical and business practices that are meant to improve quality, represent a significant shift for behavioral health providers.…”

“…9,13,14 Developing partnerships with larger healthcare systems and other support services (eg, housing) may also be necessary to ensure all client needs are addressed. 9,14 VBP arrangements, as well as the clinical and business practices that are meant to improve quality, represent a significant shift for behavioral health providers. Research conducted during earlier healthcare reforms brought about by the Affordable Care Act (ACA) 1 suggests that these providers may require significant resources to improve organizational and administrative infrastructure (eg, electronic health records [EHRs], data monitoring, reporting).…”

“…9,13,14 Developing partnerships with larger healthcare systems and other support services (eg, housing) may also be necessary to ensure all client needs are addressed. 9,14…”