General questions about ATLAS™

General data and metrics questions

Treatment Facility Survey questions

Claims measures questions

Patient survey questions

General questions

Why do we need ATLAS? Why now?

Addiction can be treated with the same effectiveness as other chronic diseases, but the use of evidence-based best practices varies widely across the addiction treatment field.[i] Public-facing quality measurement systems currently exist for many other areas of health care. These platforms bring transparency and information on facility quality and best practices to the public, which can help guide decisions and navigate individuals through potential misinformation. No such system exists for addiction treatment. To fill this gap, ATLAS will standardize quality expectations for addiction treatment facilities across all levels of care and types of treatment. This tool will be critical to individuals searching for care for themselves or a loved one, allow for the tracking of quality improvement in addiction treatment, and help to align market forces to drive adoption of evidence-based best practices.

What types of programs are included in ATLAS?
At this time, ATLAS will examine specialty addiction treatment facilities, including those listed in SAMHSA’s Behavioral Health Services Treatment Locator (a list adapted from the list of respondents to the National Survey of Substance Abuse Treatment Services - NSSATS), or licensed by the state. This includes residential, inpatient, and outpatient programs that are licensed, certified, or otherwise approved by the state to provide substance use disorder (SUD) treatment, as well as facilities that for a variety of reasons the state does not fund, license, or certify.

The system will assess any specialty addiction treatment facility who is identified as offering withdrawal management (detox) OR addiction treatment (services that focus on initiating and maintaining an individual’s recovery from substance use and on averting relapse). In this first phase it will not include halfway houses that do not provide substance use disorder treatment, individual practitioners,* including individual prescribers of buprenorphine, or jails, prisons, or other organizations that treat incarcerated clients exclusively.

* In West Virginia, ATLAS will include office-based MAT services (OB-MATs) listed under a name other than that of an individual provider, in order to better capture the treatment landscape in this state, while avoiding reporting on individual providers

Who is being assessed in ATLAS?

ATLAS will report features and quality information at the ‘facility’ level, meaning by physical location. However, some of the claims-based measures may be reported at the level of the parent organization based on the structure of data in each state, i.e. each facility will be listed, but rates for claims-based measures will be the same for all locations of a given parent organization based on state claims systems.

Will ATLAS only look at the quality of opioid use disorder treatment?

No, ATLAS will report on the quality of treatment for all substance use disorders. Some of the measures will be specific to the treatment of opioid use disorder; these will only be displayed if applicable.

In what geographic areas will ATLAS be available? How were these areas chosen? 

ATLAS is being pilot-tested in a select group of states. The states involved in this first phase are Delaware, Louisiana, Massachusetts, New York, and West Virginia. States have been selected based on several criteria, including readiness for successful implementation of the initiative and a demonstrated potential to scale the tool after the pilot. Following successful completion of the two-year pilot, ATLAS™ will be scaled nationwide.

When will ATLAS be live?

ATLAS will go live in the pilot states in mid-2020.

What will ATLAS look like when it launches?

When ATLAS goes live, the public will be able to access it through a new, free website. This website will be searchable by information that is important to those seeking addiction treatment for themselves or a loved one, including location, insurance coverage, and quality of care. It will provide transparent information on whether facilities offer services that align with evidence-based best practices that are shown to improve patient outcomes. In this first phase of the project, individuals using the website will be able to compare facilities to each other, but not to an overall standard. ATLAS also allow patients and their loved ones to report on experiences with addiction treatment programs by responding to validated survey questions similar to those used in other areas of healthcare.

Shatterproof and the analytics contractor, RTI International (RTI), are conducting feedback processes and user-requirement testing to determine exactly how ATLAS data will be displayed on the website: for example, what context information will be provided to the public, and how measures will be organized. These decisions will be guided by conversations and focus groups with experts, clinicians, and the public.

How will providers and payers be able to use ATLAS?

In addition to the public-facing platform, there will be password-protected portals. These portals will be places where providers can access their own data and compare to that of their peers to inform quality improvement efforts, where payers can access data on treatment facilities in their network, and where states can access data to inform technical assistance and other state-based initiatives. The features and display options of the portals are being determined through work with these stakeholder groups during the pilot.

How much will it cost to use ATLAS?

There will be no cost to access ATLAS. The system will be free to all users, including treatment facilities and payers in this first phase. Shatterproof is currently exploring strategies for long-term maintenance and scaling of ATLAS post-pilot, with the goal of developing a system that is self-sustaining. This may include licensing the data or membership fees for certain audiences, though such plans are still in the exploratory phase.

Who will use ATLAS?

ATLAS will be a free, public website accessible to anyone who needs it. In particular, it is a resource for those seeking treatment for themselves or a loved one, treatment providers, referral sources such as drug courts and guidance counselors, policymakers, and payers.

How will ATLAS benefit…

  • The public?
    ATLAS gives those seeking care for themselves or a loved one the opportunity to identify treatment facilities delivering care aligned with the evidence-based best practices outlined in the Shatterproof National Principles of Care. This does not replace a consultation with a healthcare provider to determine the appropriate course of care.
  • Treatment providers?
    ATLAS will give treatment providers the opportunity to compare the services and operations at their facility to others throughout the state, engage in quality improvement, and attract patients. Providers may be able to leverage their participation in the system to secure enhanced reimbursement from their contracted payers.
  • Payers?
    ATLAS will allow payers to identify, reward, and promote addiction treatment facilities delivering care that is well aligned with evidence-based best practices outlined in the Shatterproof National Principles of Care©, better aligning market forces behind evidence-based addiction treatment. ATLAS™ will also help payers ensure their beneficiaries can make informed decisions when selecting an addiction treatment facility.
  • States?
    ATLAS will provide states with the necessary quality data to inform treatment access and other state-based initiatives, such as technical assistance and policy changes.

How is the ATLAS pilot funded?

This roughly $5 million pilot is funded by a coalition of stakeholders. Two-thirds of the project are funded by Arnold Ventures and the Robert Wood Johnson Foundation. The other third is funded by a group of six health insurers: Aetna, a CVS Health Business; Anthem, Inc; Beacon Health Options; Cigna; Magellan; and UnitedHealth Group.

There is no financial cost to the treatment facilities in ATLAS. There is no direct cost to the pilot states, but they are responsible for any costs associated with additional promotion and administrative time to partner on the pilot. Shatterproof is currently exploring strategies for long-term maintenance and scaling of ATLAS post-pilot, with the goal of developing a system that is self-sustaining.

What is the role of health insurance companies in this pilot?

Health insurers play a critical role in transforming the addiction treatment system. Aligning payment practices with evidence-based medical treatment for substance use disorders is critical to improving accessibility of these services to those in need and integrating the addiction treatment system with mainstream health care. Recognizing this, Shatterproof has engaged several health insurers in our work across key programs and is committed to working with these payers to optimize practices. For the ATLAS pilot, six healthcare companies are collectively funding less than one third of the pilot (Aetna, a CVS Health Business; Anthem, Inc.; Beacon Health Options; Cigna; Magellan Health; and UnitedHealth Group). These companies do not have a governance role in the project.

These companies, and additional key health insurers in pilot states, will also support the implementation of ATLAS by informing claims-based measures. This is critical to our approach to triangulate quality information from multiple data sources. Health insurers, along with state partners, will also encourage participation in ATLAS by treatment providers in their networks.

In some cases, these groups have also committed to requiring reporting to ATLAS for eligibility for higher network tiers or distinctions.

Finally, when the ATLAS website launches, there will be a portal available to health insurers to view and analyze quality data. This will be the same data available to treatment facilities, states, and the public, but will include different displays and analysis features.

Who is developing and implementing ATLAS?

ATLAS is being developed and implemented by Shatterproof and the analytics contractor, RTI International (RTI), in partnership with pilot states and engaged payers.

RTI, an independent research institute, currently supports five national health quality reporting efforts and one large private rating system. RTI has developed and obtained National Quality Forum (NQF) endorsements for over 40 quality measures that use data from provider assessments, claims data, and consumer surveys. RTI leads large-scale quality measure collection efforts with healthcare providers including supporting over 3,000 providers in reporting measures for the Centers for Medicare & Medicaid Services’ (CMS’) Comprehensive Primary Care Plus (CPC+) project. RTI employs over 250 staff focused on substance use research, including addiction psychiatrists, former behavioral health directors, economists, epidemiologists, psychologists, and survey researchers.

How can I receive updates on ATLAS?

If you would like to receive regular updates about the status of ATLAS, please join our email list. Please indicate if you are interested in updates specific to implementation activities in one of the pilot states.

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General data and metrics questions

What is the basis for the measures that will be used in ATLAS?

When developing draft measures for ATLAS, we didn’t want to reinvent the wheel. Shatterproof started by convening a committee of experts to review national-level measures vetted by the National Quality Forum (NQF), the National Committee for Quality Assurance (NCQA), and others, as well as other initiatives by national organizations aimed at developing or recommending measures for SUD treatment. We then identified the possible strategies for accessing data on these measures and aligned them with the Shatterproof National Principles of Care©. The Committee then followed several criteria for distilling a draft measure set, including measuring consistency with the Principles, duplication, impact, relevance to providers, and ease of collection. From there, the Committee discussed the measures and received feedback on the draft measure set from key stakeholder groups, including payers and providers across all levels of care.

In January 2019, the National Quality Forum (NQF) convened an expert panel strategy session to review the proposed measure set and to provide recommendations for its implementation over the pilot. Following the strategy session, NQF held a public comment period during which anyone could submit feedback on the measures. This feedback was incorporated into recommendations for the final measure set for the first phase of ATLAS. For further information on how the ATLAS measure set was developed, and the current measure set, please view this webinar.

What data informs ATLAS?

ATLAS will utilize data from three sources: public and private insurance claims, Treatment Facility Survey, and patient experience survey (or crowdsourcing). Shatterproof is utilizing a mixed-method approach to ensure the system can capture as much quality information as possible given the fragmentation of the addiction treatment system.Treatment Facility Survey data will be supplied and reported on at the facility level.

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Treatment Facility Survey questions

I’m a treatment provider in an ATLAS pilot state, but I’m not really interested… why should I participate?

Beyond the general benefits for addiction treatment providers described above, participating during this first phase of the project will allow you to have a more direct say about the design and impact of ATLAS. Your feedback will enable Shatterproof to structure ATLAS so that it best serves the needs of all stakeholders, including the general public, treatment facilities, payers, and states. Shatterproof is currently working with state partners and commercial payers to develop strategies that incentivize and reward treatment facility participation in ATLAS, such as requiring reporting to be eligible for higher network tiers or alternative payment models, or to contract with Medicaid.

I’m a treatment provider in an ATLAS pilot state, but I’m not really interested… what happens if I don’t participate?

As state and payer leverage strategies are implemented, the specific drawbacks and missed opportunities of not participating will be identified for facilities in each state. If a treatment facility does not respond to the Treatment Facility Survey, they will still be listed on ATLAS, with an indication that this quality data is not available.

My treatment facility already reports on so many measures – how will the ATLAS data collection process fit in?

The Treatment Facility Survey that providers will be asked to respond to (starting in fall 2019) is designed to align with metrics that are already being reported, and when possible, this information will be pre-populated in order to reduce the reporting burden. Shatterproof is working with the pilot states and the involved payers to ensure that this reporting process aligns as best as possible with existing data collection, with the aim of potentially reducing future reporting to multiple stakeholders. To ensure smooth completion of the Treatment Facility Survey, facility administrators will be able to contact the RTI Help Desk for technical assistance at any time.

Should I fill out the survey at the program, facility, or organization level?

The reporting for the Treatment Facility Survey will be at the facility level – the physical site of services. If multiple programs are located at the same facility, the survey will ask certain questions for each program. If the facility is part of a parent organization with multiple locations, each facility is expected to complete the survey, recognizing that some information may be redundant. Shatterproof and RTI are currently determining how to gather this information from large organizations with multiple facility locations to ensure accuracy and reduce undue burden.

How will different levels of care and service functions within level of care be captured and accounted for in the survey?

If a treatment facility offers multiple levels of care on site, the facility will be given the option to respond to survey questions for the facility as a whole, or by the level of care.

How do we know the survey is capturing data accurately and without too much burden to providers?

Shatterproof is committed to ensuring accurate and meaningful data is collected from treatment facilities through the survey. As part of this process, RTI conducted one-on-one interviews with a sample of treatment providers across the pilot states to ‘feasibility test’ the survey. In parallel to that process, Shatterproof held provider roundtables to engage a broader group of providers to review survey questions, and to provide feedback for consideration as survey questions are finalized.

The combination of the roundtable feedback and RTI’s feasibility testing was used to inform revisions to the survey questions to ensure all wording is clear, potential barriers to answering questions are minimized, and survey questions are not unduly burdensome to providers.

Multiple forms of validation will be used to ensure that provider responses to the survey are accurate. During data collection, RTI will include certain additional follow up questions that will serve to provide additional information or verify treatment facility responses (and flag illogical responses for further review by RTI). Additionally, at the end of the Treatment Facility Survey, the CEO or director of the treatment facility is required to review and sign off to ensure the facility submission is correct.

Following data collection, RTI will randomly select a small percent of treatment facilities in each state to provide follow up data including provision of de-identified data and process verification. RTI will also perform a series of checks on data collected, including outlier analyses, and will then review any illogical or outlier data identified.

Once data has been analyzed, during the subsequent provider preview period, treatment facilities will be able to review their analyzed data and submit any corrections.

My facility isn’t like others in the area…will ATLAS directly compare us?

There will not be a benchmark or average displayed for any measures. However, the public will be able to compare two facilities side-by-side to see how the services offered by each facility vary. Additionally, the website will include hover definitions and other tools to help contextualize the different categories of information displayed to the public and offer insight into what makes for high quality treatment.

Given the subjectivity and complexity of developing a composite score, e.g. a star rating or letter grading, Shatterproof and RTI have made the decision to not use a composite score in this first phase of ATLAS.

Will I have a chance to see how data on my facility is displayed before it is made public?

There will be a preview period in early 2020 in advance of the publication of ATLAS in mid-2020 in order to allow facilities to review their information. If there is potentially incorrect information, it can be contested and corrected prior to public release. The site will also undergo user testing.

What if my facility needs additional help responding to the Treatment Facility Survey?

Facility administrators will be able to contact a help desk for technical assistance at any time. This Help Desk is managed by the project’s data analytics contractor - RTI International (RTI). Contact details for the help desk will be made available to treatment facilities in the pilot states before the release of the Treatment Facility Survey.

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Claims measures questions

How will ATLAS use health insurance data?

The states partnering with Shatterproof in this first phase of ATLAS have committed to share an analysis of their Medicaid claims (aggregated and de-identified) to inform the claims-based measures of ATLAS. Additionally, Shatterproof already has commitments from six national health care insurance companies to analyze their data to inform claims-based measures and is working with additional payers that have substantial market share in pilot states.

What if a treatment facility does not accept insurance?

If a treatment facility does not accept insurance, and therefore has no claims data, this will be displayed. While claims-based information will not be included for these facilities, information will be displayed from other sources, including the Treatment Facility Survey and patient experience responses.

Patient experience survey questions

How will the patient experience survey be conducted?
We are in the process of testing two approaches to capturing patient experience information: survey and crowdsource reviews. In the first case, we will work with treatment facilities, patient advocacy groups, and other stakeholders to connect patients and family members to a website where they will take the survey, using a unique identifier that establishes which treatment program they are reporting on. In the second case, we are exploring the benefits and drawbacks of a crowdsource platform (for example, like Yelp) for use once ATLAS is live.

What if someone goes to multiple facilities for addiction treatment?

We recognize that people with substance use disorders may see many different providers for addiction treatment. To account for this, facilities will have a unique identifier for reporting that establishes which treatment program is being reported on. People will be able to report on multiple treatment programs.

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[i] For a detailed review of the evidence of addiction treatment effectiveness, please see Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders