Sixteen healthcare payers today announced a groundbreaking commitment to adopt eight “National Principles of Care” for the treatment of addiction that will improve outcomes and save lives.
Healthcare Payers Make Groundbreaking Commitment to Improve Quality and Access to Addiction Treatment
WASHINGTON – Sixteen healthcare payers, who collectively serve over 248 million people, today announced a groundbreaking commitment to adopt eight “National Principles of Care” for the treatment of addiction that will improve outcomes and save lives. The organizations: Aetna, AmeriHealth Caritas Family of Companies, Anthem, Inc., Beacon Health Options, Blue Cross Blue Shield of Massachusetts, CareOregon, CareSource, Centene Corporation, Cigna, Commonwealth Care Alliance, Envolve Health, Horizon Blue Cross Blue Shield of New Jersey, Magellan Health, UnitedHealth Group, UPMC Insurance Division, and WellCare all agreed to identify, promote, and reward substance use disorder (SUD) treatment that aligns with the National Principles of Care.
The Principles were derived from the Surgeon General’s Report on Alcohol, Drugs, and Health, and are backed by three decades of research. Aligning care with these evidence-based Principles will significantly improve the quality of treatment for the 21 million Americans with substance use disorders.
This initiative is led by the Substance Use Disorder Treatment Task Force, which was launched in April 2017 by Gary Mendell, founder and CEO of Shatterproof, and Dr. Thomas McLellan, founder and chairman of the Treatment Research Institute and former Deputy Director of the Office of National Drug Control Policy under President Obama. This Task Force includes senior leaders from several of the payers listed above as well as:
- Donald M. Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement.
- Michael Botticelli, Executive Director of the Grayken Center for Addiction at Boston Medical Center, and former Director of Office of National Drug Control Policy.
- Jay Butler, President, Association of State and Territorial Health Officials, and Chief Medical Officer, Alaska Department of Health and Social Services.
- Charles Ingoglia, Senior Vice President, Public Policy and Practice Improvement at the National Council of Behavioral Health.
- Thomas McLellan, founder and chairman of the Treatment Research Institute, and former Deputy Director of the Office of National Drug Control Policy under President Obama.
- Gary Mendell, founder and CEO of Shatterproof, a national non-profit dedicated to ending the devastation associated with addiction.
- Penny S. Mills, Executive Vice President/CEO, American Society of Addiction Medicine.
- John O’Brien, Senior Consultant at Technical Assistance Collaborative, Inc., former senior advisor for healthcare financing at the U.S. Department of Health and Human Services.
- Daniel Polsky, Executive director of the Leonard Davis Institute of Health Economics. LDI is the leading university institute dedicated to improving health and health care through data-driven, policy-focused research.
- Cynthia Reilly, director, substance use prevention and treatment initiative, The Pew Charitable Trusts.
- Josh Rising, director, health care programs, The Pew Charitable Trusts.
- Betty Tai, Director, Center for the Clinical Trials Network, National Institute on Drug Abuse.
This first-of-its-kind announcement follows many months of work by the Task Force, including the Task Force’s kickoff meeting, co-hosted by The Pew Charitable Trusts, on September 19, and additional work among the participants in the past several weeks.
“The standard for every major disease in our country is treatment within our healthcare system using research-based medications and therapies – except addiction,” said Gary Mendell, CEO of Shatterproof and founder of the Substance Use Disorder Treatment Task Force. “For the first time in history, leading healthcare insurers and other third-party payers from across our nation have come together and agreed to identify, promote, and reward one core set of evidence-based principles for addiction treatment. Payers will now begin to establish an accountability process that will systemically change and significantly improve the way that treatment for addiction is delivered in our country.”
“Research has proven that addiction is not a character flaw, but a chronic disease of the brain.” said Dr. Vivek Murthy, former Surgeon General of the United States and author of the first Surgeon General’s Report on Alcohol, Drugs, and Health. “Today, we have evidence-based treatments that save lives, but tragically they are still not widely available, making the work of this Task Force essential and timely. Today’s commitment is groundbreaking, and it is an important step toward ensuring that we treat addiction with the same urgency and compassion as other chronic illnesses.”
“Even though science has proven that substance use disorder is a chronic brain disease that can be managed with medical treatment, only one in 10 Americans receive treatment,” said Thomas McLellan, PhD, former Deputy Director of the Office of National Drug Control Policy. “To make matters worse, a large majority of these treatment centers fail to provide patients with the personalized diagnosis, assessment, care, and monitoring needed for full recovery. This agreement seeks to change this grim reality, highlighting the types of treatment that are worth paying for, incentivizing providers to implement them, and educating the public on their importance.”
“Working together, patients, providers, and payers have the opportunity to dramatically increase the quality of substance use treatment in the United States,” said Allan Coukell, senior director of health programs at The Pew Charitable Trusts. “The payers on this task force have taken a key step by agreeing to incorporate these evidence-based principles of care into their programs. But implementing the needed changes will not be easy; we must all work together—with urgency—on the next steps, which include broader engagement with the wider stakeholder community.”
Although payers may advance the work in different ways, the Task Force will continue its work and support this commitment by 1) creating accountability for implementation; 2) providing a platform to learn and share innovative strategies; and 3) promoting these Principles with other key groups such as providers, patient and family groups, and state and federal agencies that license and fund public addiction treatment. This may include implementing a system of provider accreditation and certification, and reaching consensus on a common set of quality measures for providers, organizations, and systems of care.
Metrics will be established to measure progress on this initiative and will be published regularly.
National Principles of Care for Substance Use Disorder Treatment
- Universal screening for substance use disorders across medical care settings
Definition: Screening for substance use disorders (SUDs) should be routine in primary care and other medical and behavioral settings - such as emergency, obstetric, geriatric, pediatric, and others - especially among those with known risk and few protective factors. This should be followed by informed clinical guidance on reducing the frequency and amount of substance use, family education to support lifestyle changes, and regular monitoring. People with symptoms of a substance use disorder should receive a personalized clinical diagnosis and treatment plan from a clinician.
Rationale: Similar to care for other chronic diseases, screening for SUDs should be integrated into routine primary care. Screening is effective in preventing, reducing, treating, and sustaining recovery from substance misuse and SUDs.
- Personalized diagnosis, assessment, and treatment planning
Definition: Personalized, comprehensive evaluation prior to treatment, including diagnoses of substance use, mental and general health problems; and full evaluation of the nature and severity of family, social, and environmental problems that could affect the course of care and potential for relapse.
Rationale: No single “program” or course of care is likely to be effective for all. Personalized care is the standard in the rest of chronic illness care because it has been shown to increase initial patient engagement, continuing patient adherence and better outcomes.
- Rapid access to appropriate Substance Use Disorder care
Definition: Ability to rapidly engage individuals in the type and intensity of services that promptly meets their needs.
Rationale: Brain circuits associated with motivation, inhibition, and stress tolerance are often severely affected among individuals with an SUD. Thus, periods of motivational readiness rarely sustain and rapid access to appropriate care is critical.
- Engagement in continuing long-term outpatient care with monitoring and adjustments to treatment
Definition: Virtually all people with an SUD will need a personalized program of continuing outpatient care in a program or office-based setting, which includes regular monitoring to adjust the intensity and content of that care based on the monitoring results.
Rationale: While individuals may need a period of intensive detoxification or residential care to stabilize the craving and critical health problems associated with SUDs, this type of acute care is rarely adequate to initiate or sustain recovery. This is because drug-induced brain changes do not return to normal function for an extended period following drug cessation. Sustained engagement in long term treatment is best accomplished in the local outpatient setting. Moreover, because patient needs change as recovery initiates, regular monitoring of care is necessary to track the course of those changes and to adjust the nature and intensity of the care accordingly.
- Concurrent, coordinated care for physical and mental illness
Definition: Access to concurrent medical and mental health services either within a fully integrated healthcare system, or carefully coordinated across different systems and providers.
Rationale: The majority of people who enter treatment for a SUD also have a co-occurring mental and/or physical illness. Common physical health problems include chronic pain, sleep disorders, infectious illnesses (e.g. HIV, HCV, TB), diabetes, and hypertension. Common mental health problems include depression, anxiety, and PTSD. The most effective and efficient way to manage these problems is with concurrent, coordinated care, ideally within a fully integrated healthcare system.
- Access to fully trained and accredited behavioral health professionals
Definition: Individual evidence-based behavioral therapies from providers who have been appropriately trained and supervised. Some of the behavioral therapies that have been shown to be effective in changing problematic behaviors and relationships include Cognitive Behavioral Therapy, Individual Supportive Psychotherapy, Families and Couples Therapy, and Motivational Enhancement Therapy.
Rationale: Evidence-based behavioral health interventions have been reliably shown to improve patient recognition and acceptance of their SUD, increase patients’ sustained motivation for change and adherence to treatment, as well as enhance long-term recovery outcomes. However, the benefits and value of these therapies are best shown when providers have been fully trained and supervised in how to provide them.
- Access to FDA-approved medications
Definition: Access to FDA-approved medications and products based on the diagnosis and medical necessity. The appropriate medications or products will vary by patient-specific need.
Rationale: Not all people with an SUD will require medications; and approved medications are not available for all substance use disorders. However, when appropriately prescribed and monitored, medications have been shown to save lives (prevent overdose) and sustain positive outcomes for individuals with an SUD. Medications are most effective as part of a broader program including behavioral health interventions and monitoring (for adherence and effectiveness) and other health and social services.
- Access to non-medical recovery support services
Definition: Recovery support services include peer services (such as mutual aid groups) and community services (such as housing, education, employment, and family support) that can provide continuing emotional and practical support for recovery.
Rationale: As is true for treatment of other chronic medical illnesses, SUD treatment is enhanced when the individual’s relationships and living situation supports the healthcare objectives. Put differently, sustained recovery is difficult without addressing housing issues, employment problems, and damaged family or social relationships. While most of these services cannot be provided directly in healthcare settings, access, referral to, and engagement in these social and community services are an important part of discharge and recovery planning during the course of SUD treatment.
For more info about the Task Force, please visit: https://www.shatterproof.org/substance-use-disorder-treatment-task-force
About Gary Mendell:
Gary Mendell is the founder and CEO of Shatterproof. He founded Shatterproof to spare others the tragedy his family suffered with the loss of his son Brian to addiction in 2011. Mr. Mendell is an experienced businessman and CEO who founded HEI Hotels & Resorts and is the former president of Starwood Lodging Trust.
Shatterproof is a national nonprofit organization dedicated to ending the devastation the disease of addiction causes families. Shatterproof works to end the stigma and foster a community of support, providing evidence-based resources to support prevention, treatment, and recovery. Shatterproof advocates for changes in federal and state policy and supports the development and implementation of evidence-based solutions for substance use disorders.