We are in the midst of a fortuitous confluence of forces that makes solving drug and alcohol addiction a realistic goal for the first time.
Forces of Change
These forces of change represent an unprecedented opportunity to revolutionize addiction care in 21st century society.
Health Care Transformation
Largely due to market forces and health care reform, the health care industry is in the midst of an extraordinary and disturbing transformation. The industry is moving “away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need."1
With health care expenditures exceeding 17% of GDP and rising at an unsustainable rate, this transformation was inevitable. Some of the more powerful forces driving this change include:
- The “Value Agenda.” “In health care, the overarching goal for providers, as well as for every other stakeholder, must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.”2
- Outcomes-Based Reimbursement. The “fee for service” system is on its way out and being replaced by a value-based reimbursement model.
- Objectivity. As a result of value-based reimbursement, health care is about to become infinitely more objective. There is an arms race to see who will emerge to help health care translate the mountains of data in their Electronic Medical Records into meaningful information that helps them meet outcome and cost objectives. Fields as diverse as population health, data analytics, health informatics, chronic disease management and wellness are all in the race. In any event, getting paid in the future will require meeting rigorous and highly objective outcome and cost standards.
- Patient-Centered Care. A host of forces, including new outcome and cost standards and accountable care requirements, health care – including addiction disease management – will have to be delivered by patient-centered, primary care teams.
- Integration of Behavioral Health and Primary Care. Value-based reimbursement is leading providers to integrate behavioral health and primary care to better manage whole patient health. Given the broad incidence of the chronic disease of addiction, and its tendency to exacerbate other physical and mental health conditions, health care providers are now or will soon be in the business of integrated addiction disease management.3
- Increasing Demand. Health care reform will result in millions more insured Americans eligible for addiction treatment. Coupled with the Mental Health Parity and Addiction Equity Act of 2008, it is reasonable to assume that demand for treatment services will increase.
- Emphasis on Chronic Disease. With roughly 70% of today’s health care spending directed at treating chronic conditions, it is a virtual certainty that health care, given its new value agenda, will focus on chronic care innovation. And, as health care begins to understand that it is now in the addiction management business, chronic care models will evolve to include drug and alcohol addiction.
- Greater Focus on Employee Health. Escalating health care costs for employers and employees and the forces of healthcare transformation are accelerating the growth of corporate chronic disease management and wellness programs.
Changes in the Treatment and Recovery Fields
- Treatment Revolution. Just as health care is in the midst of a transformative period, so too is the addiction treatment industry. A value-based reimbursement system will require health care providers to 1) develop or acquire the resources to treat addiction within their four walls, or 2) enter into strategic alliances with those who can meet the qualitative standards imposed by tomorrow’s reimbursement system.
- These standards will surely require that care is delivered within a continuum of care reflecting the chronic nature of the disease of addiction. The treatment industry will likely continue to consolidate (witness the recent Hazelden-Betty Ford merger) as enlightened providers strive to remain relevant in tomorrow’s dramatically different world of value-based care. Those who excel will play well with others in the continuum and prove capable of delivering outcomes acceptable to patients and stakeholders.
- A Growing Recovery Movement. For the better part of the last two decades, communities across the U.S. have been in the midst of a transformative organizational movement of the recovery community. Influenced heavily by our friend, William White, the delivery of addiction services is being transformed in Recovery Oriented Systems of Care, designed to help more people enter and sustain wellness while reducing costs. At the center of these new community systems are thousands of people in recovery who are mobilizing to raise awareness about the disease and advance change in their communities.
Social, Cultural and Technological Forces of Change
- Rise of Social Entrepreneurship. In the last decade, a striking rise in social entrepreneurship has fostered the advancement of new solutions to entrenched social problems. This growing field is driving new business models, a reallocation of resources to neglected social issues, innovations in philanthropy and an increasing emphasis on measurement and evaluation.
- An Increasingly Flat World. Technology and other forces are fueling a rapid pace of change where ideas and information can move faster than ever. In this flat, wired world, innovation and proven solutions can be advanced at breakneck speed.
- De-Stigmatization of Other Health Problems. In our lifetimes, stigma relating to breast, testicular and colon cancer has all but disappeared, largely due to world-class efforts that attracted significant intellectual and financial resources. These successful initiatives provide a roadmap for what’s possible with the disease of addiction.
- Greater Awareness of the Power of Language. Scholars and social change leaders are increasingly aware of the importance of language as a tool for advancing change. This has fostered a movement to employ language that is person-centered and grounded in science and medicine when it comes to addiction.
- Commitment to Corporate Citizenship. Corporate America is increasingly focused on the importance of corporate responsibility, furthering social good and ensuring a positive impact on the environment, consumers, employees, communities and other stakeholders.
- Social Impact Investing and Venture Philanthropy. Social impact investing and venture philanthropy are now well-established investment categories intended to address social challenges through the deployment of capital. These harness the positive power of enterprise, setting new standards and generating measurable social impact alongside financial returns.
Public Sector Forces of Change
- Criminal Justice Reform. At the state and federal level, reform efforts are underway to address serious challenges in our nation’s criminal justice system. At the core of many of these initiatives is a shift away from incarceration for non-violent drug offenders toward greater treatment access and rehabilitation.
- National Drug Strategy. In a marked departure from past administrations, President Obama’s current National Drug Control Strategy advocates a strong public health-oriented approach to better support recovery in our nation’s communities.
- Transformative Policy. Significant changes in Federal health care policy, including the Mental Health Parity and Addiction Equity Act, 2008 Medicare Improvement for Patients and Providers Act and the Affordable Care Act, lay the groundwork for dramatically more access to addiction treatment.
(1) The Strategy That Will Fix Health Care by Michael E. Porter and Thomas H. Lee, Harvard Business Review
(2) The Strategy That Will Fix Health Care by Michael E. Porter and Thomas H. Lee, Harvard Business Review
(3) Strategies For Health Care Leaders Volume 74 Winter 2014 Behavioral Health-Expanding Access. Case Study: Solving Addiction By Delivering Value