August 2015
Opportunities and Challenges in Integration
From the ATTC Network White Paper, Integrating Substance Use Disorder and Health Care Services in an Era of Health Reform
ATTC Network Technology Transfer Worgroup:
Stanley Sacks, PhD, and Heather J. Gotham, PhD, (Co-Chairs) with Kim Johnson, PhD, Howard Padwa, PhD, Deena Murphy, PhD, and Laurie Krom, MS
As desirable as the objective of integrated care is, a variety of challenges may impede its progress. These include the needs to define and develop appropriate services, cultivate staff support for new initiatives, identify strategies for implementing change, train the SUD, mental health, and medical workforces; bring payers to the table (as they will be important drivers of integrated care); and transcend the currently bifurcated systems of SUD and mental health care.
With change and challenges, also come new opportunities. Expanding services for SUDs, including prevention and early intervention, will provide new opportunities for the current SUD treatment workforce to work in new settings. Several authors (Buck, 2011; Chalk, 2014; Dennis, Clark, & Huang, 2014; Padwa et al., 2012; Treatment Research Institute, 2010, 2011) have described the following as significant areas of change for the SUD treatment community in fulfilling the intent of the ACA:
- Behavioral health care staff will need retraining to acquire the knowledge and skills required in the new integrated service settings. Physicians will have to learn how to identify, treat, or refer patients with substance use problems. Currently, few medical schools include a comprehensive course in SUDs.
- The SUD (and primary care) workforces will both need to support health care integration using a variety of models (including locating SUD treatment and primary care in community, work and school settings; locating primary care services in SUD treatment facilities; and integrating records across services in multiple locations).
- SUD counselors will need to pursue credentialing that permits them to bill their services under Medicaid and private insurer funding standards. The funding standards may also need some adaptation.
- As the patient population expands beyond SUDs to include those with risky use, the SUD workforce will need to expand its role to include prevention, wellness, and early intervention.
- Senior SUD staff will need to be prepared to assume leadership roles on behavioral health/primary care teams.
- Clinical supervision will become even more critical.
Despite the increased evidence for the effec tiveness of integrated SUD and health services and the push toward integration through health care reform, unfortunately, early signs suggest that the integration of SUD treatment services is not receiving adequate attention in health care settings. (Lardiere, Jones, & Perez, 2011; NORC, 2011; Sacks & Chaple, 2013; SAMHSA, 2010a, b).
The ATTC Network has the resources to overcome these impediments. One of the goals of this paper is to provide the audience with critical information on models, interventions, and implementation strategies that are useful when engaging in efforts to integrate SUD and health care services.
Integrating Substance Use Disorder and Health Care Services in an Era of Health Reform also highlights the efforts of the ATTC Regional and National Focus Area Centers in "spotlight sections like the one that follows on the Mid-America ATTC:
“A Changing Health care Landscape: Can Your Organization Weather the Storm?”
The Mid-America ATTC collaborated with the State Associations of Addiction Services (SAAS) to create this model program. “A Changing Health Care Landscape: Can Your Organizations Weather the Storm?” was designed to facilitate state discussion of health care reform and integration of substance use disorder services into health care settings. The program included the following components:
- Securing buy-in from state leadership: The Mid-America ATTC met with state leaders in Iowa, Kansas, Missouri, and Nebraska to gain SSA Director support for state-specific “Can Your Organization Weather the Storm?” events.
- Assessing readiness for health care reform: State-licensed SUD treatment program executive leaders were invited to complete a free, confidential, online tool to assess their readiness for health care reform. Developed by SAAS, the Provider Readiness and Capabilities Assessment (RCA) generated an automatic health care reform readiness assessment. Treatment program leaders were encouraged to complete the RCA in advance of their state’s “Can Your Organization Weather the Storm?” event and bring it along to compare their scores with those aggregated across the state.
- “Changing Health Care Landscape: Can Your Organization Weather the Storm” events held in each state. Each event included presenters from organizations such as the National Association of County Behavioral Health and Developmental Disabilities Directors, Advocates for Human Potential, and SAAS. The events also featured a presentation on the aggregated RCA results, with comparisons of the data aggregated across the state to a national data set of 500 organizations across six key areas: 1) general management, 2) marketing, 3) information technology and data management, 4) clinical and human resources, 5) finance, and 6) provider network organizations. The program included focus groups and discussion sessions for in-depth conversations about what actions to take based on the RCA results.
- Follow-up technical assistance: The Mid-America ATTC provided follow-up TA in each state targeting the readiness areas of most concern to providers.
Read the complete white paper: Integrating Substance Use Disorder and Health Care Services in an Era of Health Reform
For more information on the ATTC Network's integration work, visit:
ATTC Network: Advancing the Integration of Substance Use Disorder Services and Health Care
