With the battle over health care in general and specifically the opioid epidemic raging on every front, it has become all too easy to become jaded and forget there is light at the end of this tunnel. Most of the coverage these issues receive now reports primarily on problems, while viable solutions are only mentioned in passing, if at all. In addition, the political formula of dividing us on our differences rather than uniting us on common ground has permeated so deeply into our culture that we now find ourselves paralyzed in the face of a completely bipartisan issue on which we essentially all agree.
No matter how much daylight we’re told lies between us, aren’t we really all on the same page when it comes to the opioid epidemic? Doesn’t virtually every citizen of our great nation want to see less of our fellow citizens buried and our nation’s wealth more effectively deployed to address this crisis? Aren’t essentially all of us socially progressive and fiscally conservative when it comes to America’s opioid crisis? We may see anecdotal stories about someone wanting all the “addicts” to die, but the reality is that every community is losing people, losing kids, and it’s hard to hate at home. America, as a whole, is tired of losing.
Fortunately, we find ourselves in a unique position regarding our opioid epidemic. It is a very rare occurrence when the most effective way to address a problem also happens to be the least expensive way to address that problem. Implementing such a solution will however require us to be bold—bold on a budget, but bold none the less.
The simplest, cheapest, most effective way to start seriously addressing the opioid crisis in this country is to shift our entire treatment system from an acute care crisis management model to a wellness model. We need to build out subacute care recovery support services. We need a treatment industry model which deploys resources downstream to keep people well instead of laser focusing on maximizing payout per day at the highest levels of care. We need to put our resources into keeping people well because keeping people well is better for them and cheaper for everyone else. Or, to put it another way, getting people well takes resources, but having to get everyone well 20 times because we didn’t fight to maintain that wellness bankrupts the entire system.
While we could debate the issue of where to find the resources to build out subacute support services in circles indefinitely, there’s a very easy way to kick this off and let the free market sort it out. Quite simply, we need to shift the entire substance use disorder treatment industry to an outcome based reimbursement model. Under the current fee for service model, the substance use disorder treatment industry is plagued with fraud and profitability is directly increased by the number of readmissions a facility has (i.e., failure is more lucrative than success). That all disappears overnight the day we switch to outcome-based reimbursement because a facility only collects 50 percent of a single code billable rate during treatment and is then given an additional 100 percent (for a total of 150 percent) of that billable rate if there are no additional acute care episodes for an entire year. If there are, the treatment facility simply accepts the 50 percent and takes the loss.
It’s quite simple, and it gives us a much-needed win. Good facilities do better, bad facilities close, hundreds of millions of dollars per year are cut from behavioral health care costs, insurance providers can pass savings to their customers in the form of lower deductibles and lower out-of-pocket maximums, which in turn increases access to care. Highly effective subacute care support services such as collegiate recovery communities, recovery high schools, peer support, alternative peer groups, and recovery community organizations get funded very quickly because successful outcomes directly affect reimbursement. Most importantly though, it costs zero dollars to implement so everyone can get on board with a big step towards solving the leading cause of death for an entire American generation.
If you are interested in reading more about this topic, I have included a link to the original open letter: Outcome Based Insurance Reimbursement For Substance Use Disorder Treatment.