“Both my son and I have been victimized by this broken [addiction treatment] system. I have entrusted professionals with my son’s health and have rarely felt that he received effective care. It seems to be a business fraught with greed, false hope and ridiculous fees that play on parents' worst fears and anxiety.”
As this quote from the Partnership for Drug-Free Kids Parent Blog illustrates, the stakes of not providing addiction treatment quality measures are high, so I am pleased that the 2018 opioid bill, called the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act, includes two new policies related to measuring the quality of opioid use disorder (OUD) treatment. We need this bill to begin to help patients and their families find quality, reputable addiction treatment.
The experience described above is, unfortunately, all too common. Individuals and family members searching for treatment have few ways to identify providers that are delivering effective treatment. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health, 20% of adults with unmet need for substance use disorder (SUD) treatment said they did not get treatment because they did not know where to go for care.
Individuals and their families who scan the Internet to find services—one of the most common ways to identify treatment providers—are confronted by an array of providers claiming to offer high-quality care. Online provider directories that purport to link patients with providers are sometimes driven by patient brokering schemes that refer patients to providers for a fee—without any effort to determine the most appropriate form of treatment.
Payers and health plans trying to contract with the best providers for their beneficiaries are faced with a similar lack of credible information on provider quality. The sad irony is that addiction treatment can be highly effective. Medications, such as methadone and buprenorphine, have been shown in numerous, large randomized clinical trials to significantly reduce the chance of dying and to significantly increase a person’s chance of being able to function in major life domains, such as work and family. Unfortunately, most addiction programs are not providing effective treatment. Less than half of addiction treatment programs, for example, can prescribe any of the medications approved by the Food and Drug Administration to treat opioid or alcohol use disorders.
The SUPPORT bill includes a requirement for the U.S. Department of Health and Human Services to start measuring the quality of opioid addiction treatment and that the State Opioid Response (SOR) Grants—which provides states with almost $1 billion to expand access to OUD prevention and treatment access—include funding to develop the necessary infrastructure to measure treatment quality.
Together, these initiatives can help to start to develop credible information that patients, families, payers can use to select high-quality treatment. However, those of us who have spent years developing and implementing quality in health care know that developing good quality measures is complex, so the adage of “what gets measured gets done” needs the following footnotes:
- If the measures are meaningful, reliable, and valid
- If the data do not require hours of data collection from overtaxed providers
- If the measures are actionable and providers have the means to improve the measure
I see these challenges play out daily through my work with government agencies and other clients who use data to measure and improve the response to the opioid crisis. And although the challenges are not insurmountable, they require careful planning, expertise, multistakeholder collaboration, and ongoing evaluation
In our work to develop actionable and meaningful quality measures for opioid treatment, we are following a rigorous process, which is outlined below.