title: Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach.
abstract: Historically, publicly funded substance use disorder (SUD) treatment services in the United States have been disorganized and inefficient. By reconfiguring and linking services to create systems of care-services, structures, and processes that are purposively interconnected to treat SUD systematically-health systems can transform discrete service components into cohesive service systems that comprehensively and efficiently treat SUDs. In this article we: (1) articulate the potential benefits of organizing publicly funded SUD services into systems of care; (2) review basic principles underlying theories of SUD system organization; (3) describe the mix and configuration of services needed to create comprehensive, integrated systems of publicly funded SUD care; (4) elucidate how patients can flow through systems of SUD services in a clinically sound and cost-efficient manner, and; (5) propose eight steps that can be taken to create systems of care by identifying and leveraging the strengths, assets, and capacities of SUD service providers already operating within their health care systems. In July 2015, the Centers for Medicare and Medicaid Services (CMS) announced opportunities for states to redesign their Medicaid-funded SUD service systems. This paper provides considerations for SUD system design and development.
authors: University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025. Electronic address: hpadwa@ucla.edu.
authors: Howard
authors: H
authors: Padwa
authors: University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025. Electronic address: durada@ucla.edu.
authors: Darren
authors: D
authors: Urada
authors: Advocates for Human Potential, Inc., 490-B Boston Post Road, Sudbury, MA, 01776. Electronic address: pgauthier@ahp.net.
authors: Patrick
authors: P
authors: Gauthier
authors: Oregon Health & Science University, School of Medicine, School of Public Health 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239. Electronic address: rieckman@ohsu.edu.
authors: Traci
authors: T
authors: Rieckmann
authors: Robert Wood Johnson Foundation Clinical Scholars Program, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Boulevard, Suite 710, Los Angeles, CA, 90095. Electronic address: bhurley@ucla.edu.
authors: Brian
authors: B
authors: Hurley
authors: University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025. Electronic address: desireec@ucla.edu.
authors: Desirée
authors: D
authors: Crèvecouer-MacPhail
authors: Vermont Center on Behavioral Health, Department of Psychiatry, University of Vermont, 1 South Prospect Ave., Burlington, VT, 05401. Electronic address: rrawson@mednet.ucla.edu.
authors: Richard A
authors: RA
authors: Rawson
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D017150:Public Sector / Q000191:economics; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D014481:United States
keywords: Medicaid; Organized delivery systems; Public policy; Substance use disorder services