Collaboration with addiction treatment providers is critical to the success of the Shatterproof Rating System for Addiction Treatment Programs. As a provider of addiction treatment, you are on the front lines addressing the nation’s opioid and addiction epidemic. You know the challenges and barriers of this space, as well as the incredible impact you have on the lives of those suffering with substance use disorders (SUDs). Providers across all levels of care and settings have been engaged in the development of this project and have shaped our approach, implementation plan, and metrics.
As we shift toward implementation, we are looking to providers in the states where we are piloting this project to continue to shape it, provide input, and identify areas for technical assistance. Your interest in and commitment to quality improvement, and your engagement in this project, have the potential to transform this system.
Why is a rating system needed?
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. Rating systems currently exist in many other health care settings, bringing transparency and information on program quality to the public, which can help guide decisions. No standardized measurement system exists for addiction treatment.
The Shatterproof Rating System for Addiction Treatment Programs is based on the Shatterproof National Principles of Care, and will begin to standardize measurement of addiction treatment program across all levels of care and types of treatment. This will allow market forces to drive adoption of evidence-based best practices and track quality improvement in the addiction treatment space.
The Rating System will integrate data from multiple sources to inform treatment program ratings. These ratings will then be made available via a free, public website for those seeking treatment for themselves or a loved one. This website will also serve as a valuable resource for treatment programs and other referral sources such as drug courts, guidance counselors, policymakers, and payers searching for accurate information on high-quality programs in their region.
Individuals using the system will be able to filter search results by features that are important to them, such as location and insurance coverage. It will also provide transparent information about whether programs offer services aligned with evidence-based best practices shown to improve patient outcomes, and will allow consumers to report their own experiences with addiction treatment programs. Click here for recent updates regarding the Rating System display, including the determination that the pilot will not include composite score.
In addition to the public-facing platform, there will be password-protected portals for providers, payers, and states. Providers will be able to access their own data and compare themselves against industry data, aiding them in targeting quality improvement efforts. Payers will be able to access data on providers in their network, and may eventually reward or otherwise incentivize high performers. States will be able to access data to inform technical assistance and other state-based initiatives.
Our current pilot
The Rating System is being pilot-tested in a select group of states in 2019-2020. States have been chosen based on several criteria, including capacity for successful implementation of the pilot and demonstrated potential to scale the Rating System after the pilot. Following successful completion of the two-year pilot, the Rating System will be scaled nationwide.
At this time, the Rating System will examine specialty addiction treatment programs included 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) as well as programs identified by state licensure lists as missing from the Treatment Locator. The Treatment Locator includes residential, outpatient, intensive outpatient, and opioid treatment programs that are licensed, certified, or otherwise approved by the state to provide SUD treatment, as well as private facilities which the state does not fund, license, or certify. This does not include individual physicians or providers treating SUD.
State partners, including Departments of Medicaid, Public Health, and Mental Health, as well as Single State Authorities, have committed to share data, encourage and leverage their contracted providers to participate, and work with Shatterproof to increase awareness of the Rating System.
Shatterproof has partnered with Research Triangle Institute (RTI) to collect and analyze the data and generate the ratings. The Rating System pilot is majority funded by two major foundations, and the remaining one-third is funded by six national health plans.
The data and metrics
The Rating System measure set was created by a committee of quality experts, revised through a series of focus groups with payers and providers of addiction treatment, and pressure tested by an expert panel convened by the National Quality Forum. The measure set will be finalized following a feasibility testing of the measures in the summer of 2019.
The Rating System will utilize data from three sources: insurance claims, treatment program surveys, and a consumer experience survey (or crowd-sourcing). Shatterproof is utilizing a mixed-method approach to ensure the Rating System can capture as much quality information as possible, given the fragmentation of the addiction treatment system. Insurance claims and provider survey data will be reported on at the facility level.
To ensure the Rating System continues to be meaningful and keep up with the latest evidence and best practices, measures will evolve each year as new measures are introduced and existing measures are further refined or retired.
The treatment program survey
Starting in the fall of 2019, all addiction treatment programs in pilot states will be asked to respond to an online survey to begin to track and inform the Rating System. The survey is being designed to build on existing metrics, and when possible this information will be pre-populated in order to reduce programs’ reporting burden. Program administrators in pilot states will be able to contact the Rating System Help Desk run by RTI for technical assistance at any time.
Shatterproof, pilot states, and the involved payers are working to ensure that this process aligns as best as possible with current data collection, with the aim that it may reduce the need to report similar data to multiple stakeholders. The Rating System will also display accreditations or certifications, although this is not required to participate.
To validate the treatment program survey, there will be validation checks, an attestation, and random checks in the form of additional questions or documentation review for select programs. Data from alternative sources will also be used to validate self-reported information when feasible: for example, triangulating from claims data.
Importantly, programs that do not respond to the survey will still be listed on the Rating System website, with an indication that this quality data is not available.
The Rating System will give treatment programs the opportunity to compare themselves against their colleagues throughout the state, target their quality improvement efforts in a more meaningful way, and stand out to patients seeking treatment. Programs may also be able to leverage their participation or rating to secure enhanced reimbursement from their contracted payers.
Participating during the pilot allows you to provide input on the design and impact of the Rating System. Your feedback early in the process will shape the structure of the Rating System so that it best serves your needs and the needs of all stakeholders, including consumers, payers, and states in directing resources, supporting providers, and identifying top-performers.
Following the lead of rating systems in other areas of health care, such as hospitals or nursing homes, the aim is to standardize reporting practices, and rate all programs. As such, if a treatment program does not respond to the survey, the program will still be listed on the Rating System website, with an indication that this quality data is not available.
Shatterproof is working with state partners and commercial payers to develop strategies that incentivize and reward participation in the Rating System, such as highlighting early adopters and creating recognitions, and using the Rating System to deploy technical assistance and support. In some cases, these groups have also committed to requiring reporting to the Rating System for eligibility for higher network tiers or alternative payment models, or to contract with Medicaid.
If you are interested in helping to shape the design and rollout of the Rating System, including the survey tool, validation techniques, website display and features, and the stakeholder engagement plan in your state, we invite you to participate in your state’s “Treatment Program Round Table.” This group will have optional monthly calls to provide updates, recruit for focus groups, gather feedback, and identify opportunities to promote the Rating System, early adopters, and success stories. If you are interested in participating, please contact RatingSystem@Shatterproof.org with your name, location(s), and contact information.
The Rating System….
- IS free
- IS a resource for consumers, providers, and payers
- IS the first step in building an infrastructure for quality improvement in addiction treatment
- IS funded by a coalition of payers and foundations, and independently coordinated by Shatterproof and RTI
- IS NOT funded by certain treatment programs or pharmaceutical companies
- IS NOT intended to reduce the pool of treatment providers available to consumers
- IS NOT a purely consumer-review site like Yelp
- IS NOT finalized—it is a pilot project for an initiative with the intention to expand nationwide
- Data collection for the Treatment Program Survey will begin during Q4 of 2019
- The survey results and claims data will be analyzed during Q1 of 2020
- The Rating System will go live in mid-2020, with a provider preview period in advance to allow you to contest any potential misinformation and for user testing.