title: Public substance abuse and managed behavioral healthcare. American Managed Behavioral Healthcare Association and National Association of State Alcohol and Drug Abuse Directors, Inc.
abstract: In the interest of establishing a dialogue between state policy makers and commercial managed behavioral healthcare organizations, the American Managed Behavioral Healthcare Association (AMBHA) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD) met to facilitate collaborative efforts around the use of managed care strategies in public substance abuse systems. Although diverse in their respective opinions on numerous issues, state substance abuse directors and AMBHA representatives identified several areas of agreement on which to build future dialogues. The provision of addictions treatment is complicated by the multiple priorities established by purchasers. Clinically sound service necessity criteria must be constructed in ways that acknowledge this complexity. Uniform clinical necessity criteria are needed and must be applied in ways that facilitate, rather than inhibit, consistent access to care. Benefits plan designers must ensure a balanced relationship among benefits, outcomes and price and must hold care managers accountable for performance and results. Participants agreed that open and fair competition is in the public interest and that this competition should be structured to preserve the values that protect vulnerable populations. Because public providers have developed significant expertise in offering a broad array of effective treatment and support services, they should be incorporated into both public and private systems of care. State substance abuse authorities can assist providers in developing the capacity to participate in managed systems by supporting training, conducting managed care readiness assessments and adopting uniform treatment guidelines. More uniform performance and outcomes measures would help the field demonstrate its value and these systems should be based on streamlined data collection and timely incorporation of data into quality-improvement efforts. The addictions treatment community, like other components of the healthcare system, can benefit from the adoption of quality-improvement programs that are data-driven and outcome-oriented and that document the positive results achieved by both public and private providers.
mesh_terms: D004465:Economic Competition; D006801:Humans; D007342:Insurance Benefits; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D011635:Public Health Administration; D013219:State Government; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000592:standards*; D019966:Substance-Related Disorders / Q000628:therapy; D014481:United States