Health Care Reform
National and health care industry trends in health care are helping to reshape the addictions workplace. There is a focus on:
- Providing integrated physical and behavioral health care for individuals through teams of providers ("Medical Home" or "Health Home" depending on the context)
- Providing large integrated care systems that incorporate many levels of care, that share risk and savings (often called "Accountable Care Organization (ACO)" or "Integrated Care Organization (ICO)")
- Quality improvement and accountability for outcomes
- Cost containment and new payment models, usually some form of global payment
- Technology for administration, communication and care provision
What this means for addiction workers
- Learning new medical culture and terminology
- Being able to generate a bill for third party payers, including a managed care entity
- Working in new settings
- Professionalization of the behavioral health workforce
What this means for medical workers
- Incorporating screening, interventions, some treatments (like Brief Treatment or Office-Based Opioid Therapy) and referrals related to addiction
- Understanding the language of recovery
- Working in new settings
- Incorporating peers into health team work
What this means for organizations
- Creating integrated medical records with sufficient controls to comply with privacy provisions of HIPAA and 42CFR Part 2.
- Creating integrated billing systems
- Establishing close referral relationships, or potentially co-locating or integrating services with another type of care provider or larger health system
- Focusing on credentialing and the ability to bill for care provided
- Adapting to changing financing mechanisms
42CFR Part 2 requires that addiction-related information be held to a higher standard than the Health Insurance Portability and Accountability Act (HIPAA) requires for other health information. See the Substance Abuse and Mental Health Administration's FAQ on Substance Abuse Confidentiality Regulations.
Resources
The following resources provide an overview of steps for Behavioral Health Organizations:
- Partnering with Health Homes and Accountable Care Organizations – a guide developed by The National Council for Behavioral Health
- NIATx Healthcare reform projects and resources – such as:
- learning collaboratives
- webinars like "Becoming the Preferred Provider for Selected Referrers" and "Increase Collections from Insurance Companies“
- a guide developed by NIATx and SAAS called Implementing Healthcare Reform – First Steps to Transforming Your Organization
- The SAMHSA/HRSA Center for Integrated Health Solutions provides many resources on integrating care, and a guidance on workforce issues in Primary and Behavioral Health Integration: Guiding Principles for Workforce Development.
- The Kaiser Family Foundation Health Reform Source
- The Business Operations for Behavioral Health Collaborative was formed to provide cross-cutting, high quality training, educational opportunities, and resources for service providers to implement efficient and cost effective business solutions. Click here to find archives of past webinars.
With SAMHSA funding, the collaborative was formed by: - The Center for Integrated Primary Care at the University of Massachusetts aims to become a national center for workforce development related to integrated primary and behavioral health care, evaluation of integrated care projects, and focal point for integrated care projects in the region.
