|A Message from the Executive Director
There is a story (most likely apocryphal) that in ancient China there were three progressively worse curses which could be heaped upon your enemy. They were:
I’m not sure about the first two of these, but it is very clear that we in the substance abuse treatment field are definitely living in interesting times!
Consider some of the changes we are now living through. Medicaid underwent a multi-year planning and transition process from an all-inclusive weekly fee to a complicated APG payment system. Preparing to implement the APGs required massive and costly restructuring of clinical practice, record-keeping, and information technology. The APG system was not even implemented in the hospital outpatient clinics, and barely rolled out in the freestanding clinics, when the state announced a plan to transition to a fully capitated system. Also, in New York City, after decades of direct contracts between OASAS and the providers, we saw the phased-in introduction of The New York City Department of Health and Mental Health as a fiscal and administrative intermediary. We must also try to figure out how we fit in with health homes, behavioral healthcare organizations, and the Affordable Care Act. And let’s not forget the prescription drug epidemic, I-STOP, The Safe Act, Executive Order 38, and the incessant rumors of state agency mergers. It really is enough to make your head spin.
Without a doubt this is a moment of crisis for our field, but also a moment of great opportunity. The opportunity stems from one simple fact. The fact is we are a very effective treatment model. When dealing with chronic, long-term, opiate addiction Medication Assisted Treatment has a far greater likelihood of success than any other treatment approach. This is particularly true if the measure of success is the reduction or elimination of illicit opiate use. This is not just my opinion, but it has been proven over and over in peer-reviewed studies published in scholarly journals.
It is our job as a field to make sure that managed care entities understand this fact. Managed care companies will only succeed financially by reducing unnecessary utilization of expensive levels of health care. When a patient has a chronic addiction to opiates all attempts to control health care costs will be unsuccessful until that opiate addiction is successfully addressed. When managed care entities understand that our programs have the highest chance of success in this area, and when they understand how cost-effective our programs are, we should see a marked increase in demand for our treatment services.
Long term I’m confident that there will be robust demand for OTP services. However, the transition to managed care is fraught with difficulties, and if we are not careful we could lose valuable and hard won treatment capacity. It would be difficult to overstate the fiscal fragility of the OTP system in New York. While we now serve 40,000 patients, many of our programs operate on the thinnest of fiscal margins. Any disruption of patient flow or reimbursement, or any significant reduction in rates could rapidly result in program closure and loss of capacity. The resultant impact on the patients and communities we serve could be devastating.
That is why COMPA has insisted that the managed care entities must (at least for two years) pay at rates not less than the current APG prices, must have open provider panels which will include all OTPs, and must use a standard and transparent process for determining level of care. By working in conjunction with other advocacy organizations COMPA was successful in obtaining these protections in statute. As the start date for full capitation is pushed forward, we will seek to similarly move these protections forward as well.
We are working with both OASAS and the New York State Department of Health to make sure that the managed care roll out succeeds, and that it does so while preserving and expanding patient access to our very valuable treatment. This is not an easy fight, but it is one we must win. With the help our member programs and organizations COMPA will continue to play a pivotal role in preserving the best of our system and carrying it forward in these “interesting times”.
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