Health Care Reform

Overview

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

For addiction workers, this may mean:

  • 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

For medical workers, this may mean:

  • 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

For organizations, issues include:

  • 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: