John Cacciola, Ph.D.; A. Thomas McLellan, PhD; Kathy Meyers, Ph.D.
Improving Adolescent Substance Abuse Treatment by Increasing Quality Transparency
Over one million teenagers have a substance use disorder. Yet, when they require treatment, few adolescents, their parents or their healthcare providers know which treatment features are important and which treatment programs are effective. There is a pressing need for scientifically valid information on those key features of treatment related to favorable outcomes. Moreover, that information needs to be translated into an intuitively understandable format that offers program comparisons and guidance on which features of treatment are most important and why. Scientists at the Treatment Research Institute worked with experts in adolescent addiction treatment, parents and representatives from Consumer Report to: identify ten critical features of care that predict outcomes; develop a reliable method to accurately measure these quality features; and create an engaging website for patients and other potential purchasers of adolescent addiction treatment services. Although online quality ratings of various medical providers and “report cards” have become widely available for consumers making many health decisions, this resource has not existed for those seeking treatment for an adolescent substance use disorder. Thus, we have developed an online Consumer Guide to Adolescent Substance Abuse Treatment, an evidence-based, comparative guide of quality indicators.
Creativity and Innovation:
While quality problems in addiction treatment have generated concern, there is no widely recognized process to rate programs in a clinically comprehensive manner. There are only guidelines and models to assess quality. The creativity came from the translation of this information into a user-friendly format while retaining scientific validity. The development process included reviewing the scientific literature, creating a program interview and audit procedure, vetting materials with experts and testing in community clinics. The online Guide is built and being evaluated by potential users; young adults in recovery, parents of addicted children, and other stakeholders (e.g., primary care doctors, drug court judges) to assure a range of input. The website instructs users on what to expect from addiction treatment; helps them recognize the qualities that are likely to be most important for them; has resources for additional support; and a navigator function helps identify programs by quality, location and setting.
Empowerment is at the heart of the Guide. Consumer publications offer accurate, comparative information to make purchasing decisions about anything from health plans to televisions. This information serves critical purposes. Most immediate, it informs and directs one’s purchase. By making this information available about adolescent substance abuse treatment, we hope that these decisions can be informed by scientific evidence and quality features – rather than on marketing blurbs and anecdotal information. Longer range, informed consumers are essential for improving availability, quality and costs of services and products. Similarly, payers have limited resources to differentiate quality among treatment providers and states and insurers could make informed choices regarding their provider networks so only quality programs with critical practices would be funded or reimbursed. Raising quality will result in improved healthcare outcomes and cost-savings. Such information is a platform to pressure insurers and government agencies to reimburse critical components of care.
The Guide was developed with an NIH grant indicating its perceived scientific importance. From the outset the Guide has been developed with a public commitment to sustainability; it is part of our organizational commitment and strategic planning. We received federal and state funding to develop the Guide which indicates its perceived importance. We continue to seek additional funding and have partners (e.g., medical societies) to continuously evaluate, refine and expand it. Providing scientifically and clinically sound consumer information is central to the goals of health insurers as well as state and federal agencies responsible for treatment. Better care should result in better outcomes and lower readmission rates. If implementation of the Guide resulted in just 10% fewer treatment readmissions, it would save $23 million in Pennsylvania (Gary Tennis, Secretary of ODAP).
The Guide can be replicated directly for other locations and networks and in concept for other populations and related treatments. While the first iteration targets adolescent addiction treatment in the Philadelphia region, the State of Pennsylvania is likely our next step. We are in the process of surveying adolescent addiction treatment of private practice professionals, a first step to develop quality metrics for these providers who see nearly half of addicted teens. Through federally-funded work and a partnership with the American Society of Addiction Medicine, we have plans to identify and audit elements of effective adult treatment to develop an adult Guide. In addition, insurance companies have shown an interest in profiling their panel of providers. The expansion of the Guide to a state level, the extension to adults, and the inclusion of private practitioners will influence the addiction treatment system to serve with more transparency and higher quality.
The most direct outcome from the Guide will be the identification of more effective treatment. Other outcomes include metrics of successful implementation and positive impact. We will also measure utilization through increased website traffic and increases in the number of included programs. We envision this as a national service/product and will increase reach through additional municipalities, states, and other networks. Additionally, this service will profile programs periodically. We expect programs to improve in quality as strengths and weaknesses are identified. We will be able to document the numbers of programs improving, maintaining or declining. Real world implementation of parallel private practitioner or an adult specialty substance abuse treatment system would be considered positive outcomes. As consumers use the Guide, and as information is available to insurers, regulators and policy makers, it will change market incentives from cost-only to cost and quality.