The rating system would drive improvement by setting a standard in the industry and increasing transparency and accountability.
Five states are partnering with national nonprofit Shatterproof to create the Rating System for Addiction Treatment Programs — a system that would essentially do for addiction treatment centers what TripAdvisor does for hotels.
The system, according to the organization, will deliver “trustworthy, standardized information about the levels and quality of care offered at all types of treatment centers.”
The first three states are Louisiana, Massachusetts and New York, and they’ll be joined by two more, which Shatterproof says it will announce in the next few weeks.
After the 24-month pilot — a $5 million initiative that’s funded by the Laura and John Arnold Foundation; the Robert Wood Johnson Foundation; and health insurers Aetna, Anthem, Beacon Health Options, Cigna, Magellan Health and UnitedHealth Group — the goal is to launch the system nationwide.
Creating such a system “will drive improvement among treatment programs by increasing accountability and transparency, and it will supply states and health-care payers with the information necessary to reward high-quality care,” according to Shatterproof, which Founder and CEO Gary Mendell launched after his son committed suicide over the shame he felt about his own addiction.
Abuse of tobacco, alcohol, illicit drugs and prescription opioids costs more than $740 billion annually by way of crime, lost work productivity and health care, according to the National Institute on Drug Abuse. And according to a survey by the Substance Abuse and Mental Health Services Administration, as many as 90 percent of those who need drug rehab the most don’t receive it.
For those who do receive help, no system exists that makes it easy to choose a quality treatment program.
“The quality of care varies widely among addiction treatment programs, and individuals looking for care can’t identify high-quality programs,” Mendell said in a press release. “It is time a standard be set across all of addiction treatment, and the entire system aligns behind evidence-based care.”
Within the addiction treatment field, many addiction treatment practices are based not on what the evidence and research show best improves patient outcomes, said Samantha Arsenault, director of national treatment quality initiatives at Shatterproof, but on people's life experiences, their philosophies about addiction or on payment structures versus what is best for the patient.
“One concrete example of that is that we are in the wake of an opioid epidemic and yet 60 percent of the specialty addiction treatment programs in the U.S. don't offer a single medication to treat opioid use disorder,” she told Government Technology. “That would be like saying, ‘We are in the height of a diabetes crisis and 60 percent of the facilities that treat diabetes don't offer insulin.’”
And this is why Shatterproof finds it absolutely critical not only to bring transparency for people seeking treatment so they can locate high-quality care, Arsenault added, but also to bring accountability to adhering to those best practices within the industry.
Each of the five selected states will work with the organization to build one system that assesses program delivery of evidence-based best practices in treating substance use disorders.
Arsenault said the team is ensuring geographic and political diversity in the pilot states given the goal to expand nationwide, and they’re working toward harmonizing a standard across the country versus perpetuating the siloed nature of care that currently exists.
“We know that the providers in Louisiana are different from the providers in New York,” she said, “and being able to implement this system across both, and those lessons learned from those different settings, will help us inform and create a system that can be used across the country.”
The standards are based on Shatterproof’s “National Principles of Care,” and they’ll be used to examine addiction treatment programs’ delivery of care. The standards are:
The pilot will measure evidence-based care delivery elements that are shown to improve patient outcomes by using information from three sources: insurance claims, treatment program surveys and consumer experience.
Arsenault said that Shatterproof is primarily measuring processes and structures, and because the ability to gather patient-reported outcome data across the field in a consistent manner “isn’t quite ready for primetime,” that information is only captured in some cases.
“We are measuring a lot of processes and structures that the research shows are connected to outcomes,” she added. “For example, in terms of medication, the continuity of medication is tied to better outcomes, so we're measuring continuity for assessments. We know that programs should be using a reliable and valid assessment tool, so we're measuring that. But we aren't necessarily measuring … [that] this number of people from this program became involved in the criminal justice system.”
But moving toward patient outcomes is the goal. In the meantime, however, the team is establishing a baseline with several process and structure measures.
“We are measuring pay programs, performance and alignment with these principles of care, and in a lot of cases, we're triangulating that quality of information from multiple sources,” Arsenault said. “Claims might not provide a clear picture about one of these elements, which is why we also have the treatment program survey and the consumer experience to start to identify and color that full quality picture of a program.”
Over a two-week period in February, the three aforementioned states signed on to participate in the pilot. Each state selected has displayed a commitment to tackling the substance use disorder and opioid addiction epidemics in the country, Arsenault said, showing that the states already are aligned with what the project aims to achieve.
Massachusetts, whose opioid death rate exceeds the national average, was the first state to sign on; Gov. Charlie Baker, who authorized the Massachusetts Department of Public Health (MDPH) to not only study the epidemic more closely but also to use data to reduce substance abuse and overdose deaths, announced the partnership in mid-February. Since 2015, his administration has doubled spending to address the state’s opioid crisis.
In New York, the Office of Alcoholism and Substance Abuse Services (OASAS) will work with Shatterproof to align the Rating System with ongoing state initiatives to improve addiction treatment quality.
OASAS Communications Director Edison Alban told Government Technology that with this new rating system, patients will be better informed when making health-care decisions, and they’ll experience better outcomes as accountability and transparency are increased, and the quality of care is improved through evidence-based best practices.
“New York State is committed to combating the opioid epidemic through the implementation of new and innovative services,” he said via email. “The new rating system will help us improve the quality and effectiveness of our services and provide New Yorkers with access to the best quality care available.”
In Louisiana, the Department of Health’s Office of Behavioral Health (OBH) will head up the project — and OBH Assistant Secretary Karen Stubbs said that within about 10 days of being selected, Shatterproof was on the ground in Louisiana meeting with various stakeholders.
“We've participated in webinars, we've had introductory meetings for our providers and other stakeholders as a kickoff,” she told Government Technology. “And the Department of Health has really been a facilitator of that. We’ve set up meetings with dozens and dozens of Louisiana substance use providers to allow Shatterproof some inreach into our state to start gathering feedback and ideas from providers who are doing this every day.”
Louisiana already has worked toward curbing the opioid epidemic in the state, including the “Healthy Louisiana Substance Use Disorder 1115 Demonstration,” which allows Louisiana to “maintain critical access to opioid use disorder (OUD) and other substance use disorder (SUD) services, and continue delivery system improvements for these services to provide more coordinated and comprehensive OUD/SUD treatment for Medicaid beneficiaries,” according to a document from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services.
The state also was progressive with legislation in 2016 and 2017 in trying to combat the opioid epidemic specific to its prescription monitoring programs, she added. These are just a few of the factors that made Louisiana a solid pilot participant.
Shatterproof’s goal is a win for the industry, Stubbs said, adding that she sees the state’s participation as positive.
“They would like an objective quality rating system that is transparent to the public, so the public has a more informed choice when they're choosing with whom to receive their treatment,” she said. “Sometimes data doesn't show the whole picture, and we have communicated those concerns; that's one of the reasons we wanted to take advantage of being in the pilot, so we can have ground zero input. And I know every time they come in, they plan on doing a series of provider and stakeholder meetings.”
Stubbs said Shatterproof plans to be on the ground in Louisiana about once per month to work with the OBH and substance abuse treatment providers across the state as far as concerns and caveats.
“So, ultimately, when this pilot is over in about two years, we hope that consumers of these services will have a more informed choice about their service array,” she said. “And I know Shatterproof’s ultimate goal is that this type of quality system would be available nationally, not just in the pilot sites.”
Stubbs also acknowledges the potential paranoia that treatment providers may have as far as transparency.
“Louisiana has made it a priority to try to include providers in this and send the message that we're in it together,” she said. “We're not doing this because of the negative quality or negative outcomes of providers. I want to give providers props and credit for the tough work that they're doing. And in Louisiana, we’re trying to involve providers in this initiative, so it's not being done to them but with them.”
Following the data collection and analysis in 2019, Arsenault said a preview period for treatment programs will open in 2020 — substance abuse treatment centers will be able to view their ratings and test them before anything is made public.
“And then when the ratings go public, they’ll be made available on four sites,” she added, noting that the first is Shatterproof’s public-facing site, where anyone can search for treatment based on factors that matter to them. According to focus groups the nonprofit held with people in recovery or those with a family member in recovery, preferred search methods include by location, accepted insurance providers, specialty programs, program quality — and the ability to compare multiple programs.
Arsenault said it’s important to note that if a treatment program doesn’t submit any quality information, it will still be listed — but it will convey to the public that the program chose not to engage in the process.
The other three data portals will be password protected and offer more depth in terms of data analysis, she said.
On the portal for treatment programs, they’ll be able to see their data, compare themselves with the others in the field and identify areas for quality improvement. The second portal for “payers,” who are essentially the health insurance providers, will allow them to identify high-level providers for centers of excellence or certain distinctions. And then the portal for states will be a critical tool for identifying areas to target with their technical assistance grant funding.
“So if in a specific geographic region of the state or within a specific area of quality, there's a lack of providers performing highly,” she said, “the state can target their resources to address those gaps.”
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