Industry Insider - April 2016

Mar/Apr 2016

Vol. 2 No. 2

Reimbursement, Business Practices: Key Issues in 2016 pg.4 The Legal Beat pg. 7 Testing Matters pg. 8 Mergers & Acquisitions - Arcadia, RiverMend pg. 10 National Advocacy for California Programs pg. 12 Treatment Professionals in Alumni Services pg. 14

Crossroads Antigua’s Rokelle Lerner and Inkspirations pg. 2

Ken Seeley and the Independent Coalition of Treatment Providers pg. 5

Mar/Apr 2016

Industry Insider

Letter from the Editor We’d had a hint of it from US Surgeon General Vivek Murthy on the stage of the UNITE to Face Addiction rally in October 2015, but this was a great way to close a year of great tumult and originality. On the last day of 2015 the US Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Surgeon General formally announced the commissioning of a first-ever Surgeon General’s Report presenting the state of science on substance use, addiction, and health.

“We need to stop treating addiction as a moral failing, and start seeing it for what it is: a chronic disease that must be treated with urgency and compassion,” Murthy, the US Surgeon General, said in January. The report will assuredly examine the health effects of drug and alcohol misuse from the perspectives of prevention, treatment, recovery, neurobiology, and delivery of care.

The most significant angle, for this publication and all of the disparate constituencies we serve, is the study of the organization and financing of prevention, treatment, and recovery services within the health care system with particular attention to ethical, legal, and policy issues.

Other areas of focus in the report are expected to include • •The history of the prevention, treatment, and recovery fields • •Components of the substance use continuum (i.e., prevention, treatment, and recovery) • •Epidemiology of substance use, misuse, and substance use disorders • •Etiology of substance misuse and related disorders • •The neurobiological base of substance misuse and related disorders • •Risk and protective factors • •Application of scientific research in the field, including methods, challenges, and current and future directions • •Social, economic, and health consequences of substance misuse • •Co-occurrence of substance use disorders and other diseases and disorders • •The state of health care access and coverage as it relates to substance use prevention, treatment, and recovery • •Integration of substance use disorders, mental health, and physical health care in clinical settings •National, • state, and local initiatives to assess and improve the quality of care for substance misuse and related disorders We don’t need a prolix report to determine there is a drug misuse problem in this country. What the public might say it wants is a consensus on both treatment and, separately, recovery support services, to avert window shopping by patients and providers in a bewildering consumer landscape of states offering services.

Sincerely,

Stephen Cooke Editor, Treatment & Recovery Industry Insider

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2 Industry Insider

Mar/Apr 2016

Crossroads Antigua: Senior Clinical Advisor Authors Inkspirations

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okelle Lerner arrived at Crossroads Centre Antigua at a time of expanded growth under its new CEO, Denise BertinEpp, which includes the expansion of the Sanctuary in Delray Beach, FL; the construction of Bevon House, the transitional living house in Antigua; and multiple initiatives to enhance the reputation and presence of Crossroads in both the local and international communities. Lerner is the senior clinical advisor for Crossroads, an international detox facility and residential treatment center.

According to Bertin-Epp, “Rokelle’s worldwide reputation as a clinical adviser only adds to our continuum of care between Crossroads Centre Antigua and the Sanctuary in Delray Beach.

Her prolific work offers greater opportunities to connect and coordinate the behavioral health care services for our clients and families that we serve.”

A pioneer in the development cutting-edge treatment for children and adult children of alcoholics, and a renowned author and lecturer in the field of addiction and relationship issues, Lerner has just recently contributed to the fashion of coloring books for adults—a trend that has gone mainstream with millions of grown-ups unabashedly enjoying the hobby worldwide.

With Inkspirations for Recovery (HCI Books, 2016), for the first time a leader in the recovery field has crafted a coloring book specifically for the millions of people who are living healthier, more fulfilling lives using Twelve Step principles. Lerner’s previous works include Affirmations for the Inner Child (HCI Books, 1990), Daily Affirmations for Adult Children of Alcoholics (HCI Books, 1996), and The Object of My Affection is in My Reflection: Coping with Narcissists (HCI Books, 2008).

Renowned for her role in training counselors, psychologists, teachers, and social workers throughout the world in healing the family from the ravages of addiction, Lerner is one of the most sought-after speakers and trainers on relationships, women’s issues, and addicted family systems. Her numerous awards include the National Association for Children of Alcoholics (NACoA) Lifetime Achievement Award and Esquire magazine’s “Top 100 Women in the US Who are Changing the Nation.” ■

WHAT’S UNIQUE ABOUT INKSPIRATIONS?

• •Gorgeous original art that will captivate readers with diverse imagery— everything from mandalas and meditative patterns to nature scenes, animals, and mantras with room to create custom patterns and doodles • •Encouraging quotes and affirmations to help quiet negative thoughts • •Thick stock paper for readers to use colored pencils, markers or watercolors • •Perforated pages to encourage framing or sharing finished pieces • •How-to section by illustrator and artist Judy Clement Wall guides readers in customizing art or taking their interest further by doodling or patterning within the pages • •Blank journal pages for self-expression

BENEFITS FOR THOSE IN RECOVERY

• •A primary issue for those in recovery is the inability to find peace without the use of alcohol or other substances; coloring calms the mind and helps readers destress • •Coloring is meditative—it allows readers to stop overthinking and to simply be in the moment • •Many children who grew up in chaotic alcoholic homes missed out on the simple creative pleasures of childhood, like coloring; this allows anyone to explore their playful, creative sides • •Once free of addictive substances, people often experience a tremendous void; a new hobby like coloring can help fill the void in a healthy way and spark interest in other artistic avenues • •For people who struggle with negative self-talk or the need to be perfect, coloring is great because there are no rules! It’s an artistic activity that requires no skill set or mastery

FOR THOSE CELEBRATING LIFE on a journey though recovery, every day is a blank canvas. This captivating book will help them make their mark on the world (literally!) through original artwork and motivating mantras that encourage and support living one day at a time.

Item 9270, 72 pages, $10.95

Inkspirations for Recovery features: v More than 30 intricate designs, from meditative mandalas and soothing nature scenes to animals and fabulous floral designs v Mantras for mindfulness and motivation cover themes of courage, forgiveness, perseverance, hope, gratitude, and more v Perforated pages make it easy to tear and share v Each illustration is a vibrant reminder of our need to live life to its fullest; this book will help to make each day a masterpiece

RELAXATION. MINDFULNESS. CREATIVITY. Unwind while unleashing your inner artist with this eclectic mix of more than 30 intricate designs from Judith Clement Wall. From nature scenes and floral designs to animals and meditative mandalas, each page will help women take meaningful time for themselves while creating stunning works of art to keep or to share.

To order visit Inkspirations.com or call 1-800-441-5569

COMING SOON

Item 9238, 72 pages, $10.95

GO AHEAD . . . MAKE YOUR MARK!

4 Industry Insider

Mar/Apr 2016

Industry Trends Issues to Watch in 2016: Reimbursement and Business Practices Michael Walsh, MS, CAP, BRI-I

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s we approached the end of 2015 and the holiday season, I began reviewing the past year and looking forward to 2016. So much time and effort is spent by many in recovery attempting to live “one day at a time,” that professionally I really must take a step back every so often and really look at what it was like, what happened, and what it is like now in the treatment industry. I would like to take a moment to discuss some of the problems and opportunities I see for 2016.

REIMBURSEMENT

Just a short time ago we in the treatment industry were unable to get more than a couple of days of coverage certified for addiction treatment. Since the Affordable Care Act (ACA) and Parity have catapulted addiction and recovery into the public eye and made it more difficult for the insurance industry to marginalize and discriminate against people suffering with substance dependence, we have been getting much more time certified through utilization review than in the past. Unfortunately, getting time certified has become the easy part; getting paid for the time certified is now much more problematic.

Despite the evidence that suggests that “participation for less than ninety days is of limited effectiveness” (NIDA, 2012), we continually fight for the ability to adequately stabilize clients and find it increasingly difficult to get reimbursed. A complicated system of denials for various reasons has apparently become standard practice for the treatment of our country’s deadliest disease. The insurance industry appears to be setting up a wall that forces providers to adhere to a system set up for the sole purpose of cost containment as the goal. If you are lucky enough to be granted an in-network contract, you can depend on decreasing reimbursement per day, which results in fewer services being provided by less qualified staff. If you choose to remain an out-of-network provider and attempt to provide the latest in evidence-based practice and employ highly qualified individuals, you can most likely count on continually being denied reimbursement for those days that have been

“precertified” for any number of complex and complicated reasons.

It is astounding that the information on exactly which plans cover what and at what rate is only divulged to the providers after the services are rendered. I am a former insurance broker and have completed a master’s degree, but I was completely naive to the seemingly organized system that protects an industry that can tell you a service is covered (or not) and how much they will pay (or won’t pay) only after the service is delivered.

I currently work for a for-profit company, but we do as many scholarships or more than when I worked at a nonprofit; the difference is at the nonprofit we got to choose when we treated someone for free! Here we find out after we have completed the services whether or not we will get paid. This just doesn’t seem right.

ABUSE

We have seen media coverage of some abuses and questionable business practices being carried out in this industry. Many reputable providers have been shouting for help to clean up these abuses for the past three to five years. I understand more than most—having been the president and CEO of the treatment industry trade association—that there are disreputable providers billing for services they shouldn’t or worse, not providing. Reputable providers have been trying to rid the industry of these criminals for some time. There are some truly unconscionable things that have transpired over the years in this industry and those people absolutely should not get paid, should be shut down, and some should even be imprisoned, but that doesn’t mean the rest of our industry should be painted with the same broad brush that is being used to weed out those providers. It doesn’t make it right that licensed, certified, quality programs that provide a “covered service” should not get reimbursed because of some fine print in a policy that can be withheld until after the services are provided. How is that acceptable?

A few short weeks before this writing I had

real hope for change in the way we address the issues of treatment, prevention, and education of this deadly disease. All the 2016 presidential candidates seemed to be talking about it. Unfortunately, many of them do not really understand its complexities and its effects on individuals, families, and society emotionally, physically, and financially. However, there is hope in that many were interested enough to mention it. Some appeared to really understand the issues, and although there is no easy fix I found myself imagining that we could really bring this into the light and make some progress in the fight against this deadly disease.

Addiction was declared a disease by the American Medical Association (AMA) in 1956, and in 1991 the AMA endorsed the dual classification of alcoholism by the International Classification of Diseases (ICD) under both psychiatric and medical sections. I’m not quite as hopeful now that any real change will happen anytime soon, but isn’t it time we begin?

Our country is in the midst of what I believe has surpassed epidemic proportions and is approaching a pandemic state. We know that treatment works and that if left untreated addicts and alcoholics wind up in jails, institutions, and worse, morgues. Isn’t it time to come together and decide on a plan of action and reasonable reimbursement for services rendered? After all, these are lives we are talking about. ■ Michael Walsh, MS, CAP, BRI-I, is currently executive director and COO at HARP Treatment Center on Singer Island, FL. Former president/CEO of The National Association of Addiction Treatment Providers (NAATP), he holds a master’s degree in substance abuse counseling and is a certified intervention professional. As a certified addiction professional, he has extensive knowledge, experience, and understanding of the treatment industry from preadmission through the intervention, admissions process, case management, referent relations, client services, and aftercare coordination for patients.

References National Institute on Drug Abuse (NIDA). (2012).

Principles of drug addiction treatment: A research-based guide (3rd ed.). Retrieved from http://www.drugabuse. gov/publications/principles-drug-addiction-treatmentresearch-based-guide-third-edition/acknowledgments

Mar/Apr 2016

Industry Insider

A Coalition for Our Times Stephen Cooke

I

f one trawls the country and prowls the treatment and recovery landscape, as the Treatment & Recovery Industry Insider prides itself on doing, you find that everyone you run into affirms that their treatment center (TC) is different and has all kinds of original media to help elucidate that.

But our world too often impinges on a world of grief, where mothers lash out as to how one can possibly deduce which TCs are doing the right thing when addiction is diagnosed. Today, a new organization called the Independent Coalition of Treatment Providers (ICOTP) has stepped into that poignant vacuum, and its high profile as a provider group has immediately had an impact in making its presence known to the world of commercial payers.

The coalition is shepherded by founding member Ken Seeley, a certified intervention professional who has been featured on the A&E series Intervention. The organization’s leadership has developed a treatment plan with a streamlined focus it believes will render conspicuous a path to long-term, sustained recovery from the disease of addiction to the public and payers alike.

No small thing, the yearning to ensure that every single person, regardless of how they became addicted, actually obtains accelerated and clinically appropriate treatment.

“We have to help the Justice Department do their job, and shut down treatment centers that aren’t ethical by going after them ourselves,” said Seeley as he began another of his own renowned intervention training sessions in California in January. “If we are going to make a change together we need as many treatment centers that are doing the right thing on board. We will not work with centers we know are doing the wrong thing.”

The National Survey on Drug Use and Health (NSDUH) has estimated that roughly about 27 million Americans over the age of twelve were addicted to or had abused some level of drugs or alcohol in 2014 (SAMHSA, 2015).

ICOTP’s genesis really began in 2014 when a few industry payers approached several large commercial insurers to figure out a way to deliver a model of premium care that the payers could envision properly reimbursing. The “great discovery of the age” was that the insurers want to know who the best providers are and how to get the best care value. After just a year of birthing pains, the clear mission of ICOTP is reminding many of the independent centers of why they got into the behavioral health field in the first place.

ICOTP is making significant advances in its bid to educate the public on ethical treatment and the continuum of care. Its newspaper ads have zeroed in on those public perceptions of the lack of oversight and recent news of unscrupulous business practices in the addiction treatment industry, where a black cloud has tarnished the reputation of an innovative community that once led the nation

Independent Coalition of Treatment Providers Our nation is faced with an epidemic!

An epidemic of the disease of addiction.

Addiction to street drugs, prescription drugs and alcohol.

• Twenty-five-25-million Americans are addicted today!

• Families are being torn.

• Quality care for treating this disease is being undermined by those who prey on the suffering.

W

e believe it is time for families, providers of quality care and the payer community to

support the United States Justice Department In a thorough investigation and indictment of those abusing the system. These abuses are defrauding insurance companies and wasting necessary resources needed for quality care required under the Affordable Care Act. The Independent Coalition of Treatment Providers believes those seeking sobriety deserve treatment providers who honor a code of conduct and offer standards of care

based upon medical necessity.

Our mission is to encourage ethical practices, ne compliance, and accreditation.

We call on our Justice Department to act now to clean up abuses in order that those seeking sobriety, their families, and communities may be restored to good health.

Call Us Toll Free (800) 514-8911 or Visit Our Website: www.icotp.com

ADVOCATES COLLABORATING FOR CHANGE Southworth International John Southworth, CEO

Billing Solutions Jimmy Rizzo, CEO

Ken Seeley Communities Eric McLaughlin, CEO

Oregon Trail Recovery Ben Randolph, CEO

Sagebrush Vanessa Vergnetti, CEO

Dynamic Life Recovery Centers Dennis Nystrom, CEO

A New Start Treatment and Recovery Center Michael Welch, CEO

Nsight Psychology & Addiction Mary Helen Beatificato CEO & General Counsel

Medivance Billing Service, Inc. William McCormick, MBA, CEO

Mandala Healing Center Peter Walstrom, CFO

Fort Lauderdale Hospital Manny Llano, CEO

The Kiloby Center for Recovery, Inc. Scott Kiloby, CEO

Liberation Way Jason Gerner, COO

Evolve Treatment Center Mendi Baron, Founder/CEO

Sprit2Spirt Judy Crane, CEO

BRC Recovery Marsha Stone, CEO

Alina Lodge Micheal Hornstein Executive Director

Kemah Palms Recovery Dr. James Flowers, CEO

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Mar/Apr 2016

in quality addiction treatment.

The Coalition will provide a forum with a commitment to ethical business practices and be ready to stand against unqualified proprietors inundating the field with subpar treatment practices. Seeley already led a team of such providers to Virginia to meet with the payers and is in no doubt that addiction professionals need to take responsibility not only for that perception, but for positive change.

“For so long the providers and insurance companies have been at odds, but now for the first time we are actually working together,” added Seeley. “If we hear an indictment is about to happen, we want to show the country we are behind it and want to help. Not everyone is doing things the wrong way and we are going to be the ones asking the payers to work with us as we work with them during this process.

They were very receptive to our cause.”

Allowing payers to firmly identify those centers that are providing sound and ethical treatment is attractive to engaged insurance companies too, with Seeley seeing that mutual goal of sustained and affordable recovery in a rapidly changing payer environment. As a grassroots nonprofit, the focus is less on the political pull that a newly energized NAATP might seek and more on the focus for all insurance payers. The purpose of the ICOTP that Seeley and his team have already galvanized is twofold.

“The first reason is to address some abusive practices by some that are draining resources needed for successful treatment,” says Seeley.

He continued by saying

We are all aware of treatment providers involved in these practices. Unfortunately, the payers of addiction treatment (insurance and government agencies) and the public have no way of separating the “good guys” from the “bad guys,” and we all are stained by the bad guys. This severely hinders any efforts at working directly with payers to provide effective long-term treatment standards that have been proven to work. Our coalition is working directly with the Joint Commission to develop a “Clean Hands” pledge of ethical, sound, and legal treatment practices that are transparent and verifiable.

“We know the value of what data means in this equation,” says Bill McCormick, president of Medivance Billing Service. “Gathered information provides us with an abundance of insight into how we can strategically design suitable pathways for dealing with countless of issues and demands. It also affords the opportunity to use a set of metrics to analyze patterns of behavior and how we should respond to the serious addiction problem we have in this country.”

The second purpose of the coalition is to show payers how they can save money and have increased success in addiction treatment by using a long-term care strategy that has been proven to work. “Recovery is a process. The five-year process is what leads to high success rates,” added Seeley. “Look at the diversion programs for lawyers and doctors. These programs enjoy around a 75 percent five-year success rate, far greater than we see with any other traditional programs, proven to be successful for physicians, pilots, and some court systems.

These methods can be directly applied to nonlicensed individuals that we treat every day. The coalition’s program is a five-year, chronic care model which payers are unequivocally seeking.”

The five-year plan includes the full continuum of care and Twelve Step support, plus a dedicated recovery advocate who follows the patient for five years, which Seeley is propelling to be an accredited position itself in the future. As one of America’s best-known interventionists, he naturally gravitates to its importance in the equation: “It

should be difficult. You shouldn’t be able to call yourself an interventionist without meeting certain standards,” Seeley says. The five-year plan also leverages random drug testing that parallels the drug court model. Seeley estimates a state might only pay $6,000 per patient, per year for the service.

As one might expect, the interventionist is a fulcrum for this model, involved for the full five years, keeping the families on board, in essence providing ongoing leverage similar to what a licensing board provides physicians and pilots, and then unleashing the best work of America’s independent TCs. The other components of this program after an initial intervention include: • •An integrated ninety days of treatment for medical, psychological, and addiction issues • •Strong aftercare planning that continues after this initial ninety-day acute stabilization • •Continuous random drug screen monitoring for five years Payers are seeing a way to meld the successful and proven professional programs into a program applicable to many others with addiction issues.

Direct interaction with the Joint Commission will provide payers with a level of confidence in what they are paying for in a credentialed center. With such cooperation, clinical teams will be under the microscope to align proper and ample documentation related to the therapeutic assessment and operational efficiency reviews imposed by various insurance payers, and the coalition aims to solve the quality and cost concerns of insurers—big ones such as Aetna, Cigna, and Humana—who’ve sought a model that would be mutually promising for payers and providers.

“They do understand the problem,” Seeley says. “They hear us loud and clear. And working together is where they see a solution.”

“The endorsement of the commercial insurance industry will be a boon,” says McCormick. What is pioneering about the coalition is that it’s not only payers and treatment providers who are on board with the initiative, but there are also legal teams, the Joint Commission, ancillary providers, and vendor organizations. “We have the full spectrum that represents our space,” says McCormick. “That diversity creates a level of strength.”

The coalition is poised to organize an intensive, collaborative summit within the next eight months, most likely in September, for its growing stakeholders to align further—and coalesce its goals more effectively— with what addiction treatment looks like today.

As Dr. Roland Reeves, a pivotal player with ICOTP from his renowned independent center Destin Recovery affirms, “Recovery’s a process, not a destination, and the public needs to see that with a new transparency.” ■ References Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Behavioral health trend in the United States: Results from the 2014 national survey on drug use and health. Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf

Mar/Apr 2016

Industry Insider

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The Legal Beat Looking Back, Looking Forward Jeffrey C. Lynne, Esq

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rom a public media perspective, 2015 may be the year that the recovery industry and the greater recovery community had its “coming out party.” Social media campaigns, coupled with the growing face of the national opioid/heroin epidemic, placed the discussion of addiction front and center on the minds of all Americans as the largest health care epidemic in our nation’s history. People from all walks of life elected to forego the anonymity of their recovery to demand that our country collectively take definitive and decisive action towards eradicating opiate addiction and the effective legalized drug dealing perceived to be perpetuated by health care providers.

In October 2015, the nation experienced the first national addiction rally of sorts, as tens of thousands of persons from various backgrounds came to the National Mall in Washington, DC to demand a larger federal response to the national epidemic. The UNITE to Face Addiction rally hosted a divergent group of people from various socioeconomic demographics, who converged around a single point of interest and demanded immediate and massive cultural change in how medicine and health care are practiced in our country.

Concurrently, 2015 began significant discussions on the effectiveness of cost control related to the Affordable Care Act (ACA).

While the Office of the President has publicly called the ACA a success, there appears to be continued concern from a cross-spectrum of Americans about how we pay for health care, accessibility, and the continued rising costs of premiums. By way of example, within the State of Florida, Cigna announced their election to leave the state due to what they claim to be overwhelming fraud within the substance use disorder (SUD) treatment field. At the opposite end, people across the country continue to assert that the Mental Health Parity and Addiction Equity Act of 2008 still has not lived up to its hype as readily accessible. Fullcontinuum treatment for substance use disorder remains a Rubik’s Cube, depending upon state of domicile.

Within 2015, we also saw the continued emergence of a cohesive force for change emanating from the Young People in Recovery (YPR) movement and the further establishment of collegiate recovery programs at universities and colleges in every state. National leaders in this space—such as Andrew Burki of Life of Purpose Treatment—continue to make a difference at college campuses across the nation.

At the congressional level, 2015 also saw significant discussion on legislative and policy direction that reaffirms the need for a comprehensive approach to SUDs and the misuse and overprescription of opioids. The proposed Comprehensive Addiction and Recovery Act (CARA) would enhance existing block grant programs to the tune of up to five million dollars to expand education and prevention; expand the availability of naloxone to law enforcement agencies and other first responders; expand resources to identify and treat incarcerated individuals suffering from addiction disorders; expand disposal sites for unwanted prescription medications; and strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion.

CARA also underscores the continued strength and dominance of the discussion by the pharmaceutical industry, as medicationassisted treatment (MAT) continues its upward trajectory as the primary source of initial treatment. Addiction professionals are being forced to reconsider prior policy positions about the role that MAT could or should play in longterm sobriety.

On the presidential campaign trail, America’s heroin crisis has risen to levels that are demanding attention going forward into 2016, as candidates from both sides of the aisle call for action, particularly in the first-in-the-nation Primary state of New Hampshire, where heroin overdoses have soared. From town hall forums to presidential debates, it seems the addiction crisis has taken the candidates by surprise, which may bode well for the short-term conversation about addiction, but remains part of the larger national discussion on social policy issues, which tends to get drowned out in

the black hole that is Congress. Still, first Primary states such as New Hampshire may be the testing ground for the national tolerance of discussing SUDs consistently and openly.

Looking forward to 2016, the topic of recovery residences (i.e., sober homes) will continue to be important, at least at the local level—health care will begin to accept paying for treatment, but continuing to deny that housing is an integral part of recovery. From an urban planning perspective, the place and placement of such homes, their concentration within communities, and their regulation will continue to be a point of great concern.

Throughout 2016 and into 2017 and beyond, our nation’s cultural values will likely see a seismic shift as marijuana usage becomes more acceptable, and treatment programs for high-potency-grade misuse become more ubiquitous. A likely antagonism will surface in society, demanding that marijuana’s place in our communities is medicinal and not recreational; from growers and distributors who will experience high-profit margins to treatment centers that will be torn between patient care and profit margins.

We will surely see a paradigm shift in how Americans view cultural norms about drugs, addiction, recovery, and housing. The discussion moving forward will be to determine at what point we cross the line and allow the integrity of the recovery movement to be compromised by the need to be financially self-sustaining in light of the lack of public appetite to fund any social service. ■ Jeffrey C. Lynne, Esq., opened his own Delray Beach, FL law firm in 2010 and merged it with fellow land use attorney Michael S. Weiner and commercial litigator Laurie A. Thompson to form Weiner, Lynne, and Thompson, PA. As a result of his work with substance use disorder (SUD) treatment and housing providers, Mr. Lynne has forged a reputation as a leader in defining the role played by SUD treatment within our communities; he has led discourse about the need and right to provide safe, affordable housing for those in treatment in addition to those established in recovery.

8 Industry Insider

Mar/Apr 2016

Testing Matters Drug Testing in 2016 and Beyond Brian Crowley

I

’m sure many, if not all, of these questions are on our minds as we’ve entered this new year.

• •What are the key factors influencing payers and providers these days?

• •Will the new paradigm for medical necessity create the “payer-friendly” environment providers are seeking?

• •What makes sense anymore in the lab business?

• •What are payers really gearing up for?

• •What are providers doing to get paid and what’s succeeding?

The reality is that our industry is in a state of massive change in many areas—some good, some not so good.

Florida is most likely the state experiencing change on a cataclysmic level when it comes to urine drug testing (UDT) in matters of medical necessity, reimbursements, and patient census numbers.

The writing is on the wall: UDT is dead for the profiteers. Changes to federal billing and coding are sending tsunami-size changes across the industry. Commercial payers are denying testing for the majority of out-of-network labs based in Florida, while others have dramatically reduced payments, in some cases by 80 percent.

So now the question to ask is this: Is the lab business sustainable for those other than the mega labs that are either locked into in-network agreements with payers or have volume on their side to stay alive?

As one Florida legislative staff member put it, “The market is correcting itself.” That may sound great, but the bloodbath that’s starting to

ensue between payers and providers is truly just beginning.

Providers are asking how this will impact their relationships with payers and patients, even if they aren’t in the lab business. Well, it’s sure to increase costs for patients on the front end with greater enforcement of patient responsibility deductibles and copays.

Unfortunately those labs and providers who have toed the line and done business by the book are hurting tremendously due to uncommonly low patient census and unusually low reimbursements. Payers seem to have literally stopped paying for services or reduced the frequency criteria whereby it seems to make no medical sense and even may increase the risk to the patient of relapsing and continuing the “cycle of insanity” chain of events.

In this month’s “Testing Matters” column, we’re going to set the scene for what aims to be a new level of discussion about the key factors impacting the behavioral health industry and explain the purpose of “Testing Matters” going forward.

“Testing Matters’” core purpose is to identify key issues that are affecting the health care industry and seek to engage key stakeholders through proactive discussions, identifying problems, and focusing on solutions that create positive, lasting impact.

We will provide an interactive media platform that connects and informs stakeholders with accurate and timely expertise in key topics of interest.

We will test programs and business models in the market today to evaluate their level of sustainability in today’s ever-changing testing environment.

As a stakeholder, we believe you are very interested in these matters and expect to see new concepts being created for the industry to evolve in a positive direction that drives competitive advantage through accountability and innovation.

So with that, we invite you to please tell us what topics most interest you, what you would like to see brought to light, and what you would like to hear from perspectives and trusted sources you can depend on for insight.

Go ahead and sign up, as the first one hundred contributors are immediately entered into a contest to win a free weekend for two to a major city in the United States. Check it all out at www.TestingMatters.net. ■ Brian Crowley is the founder of Integra Enterprizes. He has experience in the business of behavioral health, specifically drug testing, strategic business, and leadership development. He is chairman of the FBHA Committee on Laboratory Services.

Mar/Apr 2016

Industry Insider

“Y”: How Change Can Start with a Letter Suzanne Spencer

D

ear industry and fellow colleagues,

I am writing this letter to you in hopes that instead of being overwhelmed by the greatness of change that has to happen in our industry on so many levels, that you might instead be inspired to know that change can start with a simple letter in the alphabet: “Y.” In fact, on an even more personal level, it can start with your “Y.” I know many of you will agree that much in our industry has to change. I hope we will end up agreeing on the way in which this change has to take place. You see, the reason we are seeing the travesties in the industry—client brokering, displaced residents, insurance fraud, and an ever-growing list of predatory practices—I believe is because we no longer know our “Y,” (i.e., our “why”).

It is clear that numerous for-profit strategies have left our industry in a crisis, and while it is easy to blame this on our health care system, good operators versus bad operators, and lack of oversight from government agencies, laws, and any number of other distractions, but the truth is that the crisis we face is far more ominous. This is a crisis of purpose and meaning, and the solution to changing it is getting back to our “why.”

I have been in the industry for close to ten years now, and I wanted to share with you something that I hear has been on the minds of many. Many of you know that I am not an addict, although like most of us, I have had recovery in my life. What you may not know is my “why.”

So the ultimate question is this: How do you find your “why”? The answer is a yet another simple question: Why did you choose this business or this career? Some of you may answer “money,” but money is simply a result. Keep digging for answers until you find the one that makes you cry.

For the greater majority of you it will be because of some deeper meaning, purpose, and intrinsic value. What is amazing about asking this question is that when you know your “why,” you will no longer be able to work for organizations that displace people for a lack or insurance benefits. You will no longer engage in urine drug testing scams. You will no longer be able to watch and be part of taking advantage of a vulnerable population that turns to us for care, help, and recovery. The whole foundation of the career and businesses you build will be grounded on your “why.”

So I promised you to share with you my “why.” My “why” is because I want to bring back healthy families. I want children to grow up in a world that allows them safety, family, and connection. My heart breaks at the thought that that so many amongst us do not know the value or believe in the purpose of their lives.

I have heard it said by some that my role and efforts in the industry have garnered some power. My work and passion as executive director of the Delray Beach Drug Task Force and Living Skills in the School has never been about power, because power has never been my “why.” Those of you who have chosen to follow and participate in the efforts of what the Drug Task Force does know this to be true, because it is not your “why” either.

An industry that is in a crisis of purpose and meaning does not need a leader who has power, because it is power that has brought about this crisis. It needs leaders who inspire, and a following of like-minded people who know their “why.” ■ Suzanne Spencer is the executive director of the Delray Beach Drug Task Force. She brings leadership and a steadfast commitment to both the community and the vulnerable population served by the Drug Task Force. She has a ten-year history in the nonprofit sector, specializing in administration, communication, special events, fundraising, and leadership.

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10 Industry Insider

Mar/Apr 2016

Mergers & Acquisitions RiverMend Health Receives $60 Million Boost to Provide Evidence-Based Treatment Addiction, obesity, and mental illness are some of the nation’s most pressing health care challenges. Our team has been working diligently to develop sustainable solutions that are rooted in lifelong recovery strategies, bringing together the world’s leading experts and a nationwide network of rehabilitation facilities to conduct evidence-based treatment, research, and education.

The investment and partnership from Norwest, and the firm’s deep expertise in health services, health care outcomes assessment, and global reach will enable us to treat more patients and expand into new markets, more effectively, across the US. Edmund Bujalski (left), CEO of Rivermend Health, and Dr. Mark Gold.

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iverMend Health, the premier provider of scientifically driven behavioral health services to those suffering from alcohol and drug dependency, eating disorders, and other addiction-related diseases, has announced a $60 million round of funding led by Norwest Venture Partners. As part of the new investment, Edmund Bujalski will be appointed as CEO, with Dr. Ryan Harris, from Norwest Partners, joining as RiverMend Health’s chairman of the board and Dr. Mark Gold as chairman of the RiverMend Health Scientific Advisory Board.

The RiverMend transaction is an indicator for 2016 of how the demand for mental health services continues to escalate, while the resources needed to treat patients have plummeted. This turbulent

cycle of supply and demand has resulted in shorter treatment stays and growth in outpatient and community-based services.

“General awareness of mental health and addiction, along with research and treatment, has been shortchanged for too long,” said Dr. Mark Gold. “Together, we are advancing RiverMend’s vision of helping individuals truly treat and overcome their addictions—a lifelong commitment.”

RiverMend Health has experienced tremendous milestones as it tackles today’s biggest health issues. In its two and a half years of operation, the company has grown from four to over 350 employees across fifteen nationwide locations. RiverMend Health integrates evidence-based medical treatment methods into every aspect of ad-

diction treatment, rehabilitation, and recovery. The company’s physicians, many of whom are board certified in the specialty of addiction medicine, have direct input into all components of a patient’s treatment, from designing his or her individualized treatment program to providing personal, direct, one-on-one medical care. With that commitment to scientifically backed treatment methods, RiverMend has gathered over thirty top advisors across two scientific advisory boards, and has forged relationships with key medical centers such as Medical College of Georgia at Regents University, Northwestern University, and University of Southern California.

According to RiverMend Health CEO Edmund Bujalski,

“RiverMend Health is solving a salient issue for a historically underserved population,” said Dr. Ryan Harris, general partner at Norwest.

He continued by saying that Over the past two and a half years, the company has built recovery models that truly restore lives of patients suffering from debilitating chronic conditions. Our investment in the company speaks to its leadership in the treatment, research, and education of addiction-related diseases through collaboration with the nation’s most renowned clinicians and top treatment facilities. ■ Source: http://www.rivermendhealth.com/ news/RiverMend_Health_Launches_to_Provide_ Evidence_Based_Treatment_for_Addiction_Related_Diseases.html#sthash.s1S5ivBf.dpuf

Mar/Apr 2016

Industry Insider 11

Acadia Healthcare Buys Priory Group

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cadia Healthcare Company, Inc. has agreed to buy Priory Group, a mental health care provider known for its celebrity client list, for nearly $850 million, its biggest acquisition yet as it expands in Britain.

The deal will give the US health care provider control of The Priory Hospital in London, well-known to the British public as the treatment center where the famous have checked in over the years.

Acadia, which specializes in psychiatric and chemical addiction, has a network of more than 250 behavioral health care facilities, mainly in the US. It began its push into Britain eighteen months ago.

Chief Executive Joey Jacobs said in a statement that this strategy was supported by a “long-term increase in the need for independent sector support for inpatient behavioral health.”

Acadia said it would pay 1.275 billion pounds ($1.87 billion) in

cash for Priory, including 925 million pounds of debt, and issue 5.363 million shares to the sellers.

The stock portion of the deal was worth about $335 million, based on Acadia’s closing price of $62.46 on December 31, 2015.

Priory was bought from RBS in 2011 by private equity firm Advent International. Advent declined to comment.

Priory specializes in the treatment of mental health problems, including eating disorders and alcohol and drug addiction. Its flagship 150-year-old hospital in southwest London has become a favorite for celebrities seeking help.

The company has more than three hundred facilities throughout Britain. ■ Source: http://in.reuters.com/article/us-priorygroup-m-a-acadia-health-idINKBN0UI16B20160104

YPR and Rise Together Merge Programming Initiatives for Adolescents

Left to right: Douglas Darby, Nadine Machkovech, and Anthony Alvarado from Rise Together.

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oung People in Recovery (YPR) and Rise Together (RT) are excited to announce that they are joining forces to improve outcomes for high-school-age students nationwide. Effective January 4, 2016, RT joined the YPR team, merging their secondary school and community speaking programs into the programming division of YPR. This partnership will improve the recovery landscape for adolescents across the country by increasing the capacity of both organizations to more efficiently and strategically serve the needs of youth and create recovery-ready communities.

Rise Together is a recovery advocacy initiative of YPR that focuses on prevention, education, and community outreach. Started in 2013 by cofounders Anthony Alvarado and Douglas Darby, the team joined YPR in early 2016. The group is comprised of those in re-

covery, family members, friends, advocates, and professionals within the community. The RT executive leadership team will provide leadership to YPR’s school speaking initiative. RT support staff and contractors will also join the YPR team to ensure a smooth transition for programming operations.

Young People in Recovery is a national grassroots organization with over ninety chapters in thirty states, delivering peer-to-peer services for young people in, or seeking, recovery. YPR aims to improve access to treatment, educational resources, employment opportunities, and housing that sustains young people in their recovery.

With this transition, YPR is better equipped to support adolescents, their schools, and their wider communities. The program is designed to educate students, teachers, and families on

topics of substance use and misuse, mental health awareness, and the development of life skills.

Since its inception, RT has impacted over 100,000 students at 150 schools across the Midwest and, together with YPR, aims to reach over 250,000 students at 350 schools by the end of 2017.

This strategic fusion of YPR and RT underscores YPR’s commitment to serving adolescents and builds on the organization’s affiliation agreement with the Association of Recovery Schools that was announced in October 2015.

YPR and RT look forward to working together to increase capacity and support services for youth and create more recovery-ready communities across the nation. ■ Source: http://youngpeopleinrecovery.org/blog/ypr-rise-together/

12 Industry Insider

Mar/Apr 2016

National Advocacy for California Addiction Programs Andrew Kessler, JD

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ashington is abuzz with talk of expanded treatment for substance abuse. While many members of Congress agree that treatment should be more widely available and more accessible, there are regulations currently in place that prevent the expansion of treatment, especially to those reliant on Medicaid services. Since upwards of 70 percent of all substance abuse treatment dollars come from a government source (SAMHSA, 2008), when Medicaid coverage for treatment is an issue, the entire treatment community is at risk to feel the pinch. Specifically, regulations that govern Institutes for Mental Diseases (IMDs) are affecting access to care.

The Social Security Act (42 USC §1396d) defines IMDs as any “hospital, nursing facility or other institution of more than sixteen beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care, and related services” (2003). The IMD exclusion is a thorn in the side of substance abuse providers that accept Medicaid funds, and has been since 1965. The IMD exclusion prohibits Federal Medicaid matching payments for care provided to individuals between twenty-one and sixty-four years of age in an IMD. In 1965, the year that the IMD rule was established, substance abuse and addiction were considered by the medical community— and to a greater extent, society—to be a mental health condition. We suspect this is the primary reason that the IMD rule has been extended to residential substance abuse treatment programs. However, in the fifty years that has elapsed since then, our knowledge of substance abuse has advanced exponentially. While there are neurological components to addiction and substance abuse, it is no longer considered a mental health disorder. Unlike institutional facilities for the treatment of the mentally ill, residential substance abuse disorder (SUD) treatment providers set finite limits on the length of stay for their patients.

States such as California face a demand for residential SUD treatment for Medicaid beneficiaries that is steadily increasing. However,

many residential SUD treatment providers are prevented both from treating Medicaid beneficiaries in their existing programs and from expanding capacity for residential SUD treatment as a result of the sixteen-bed limitation contained in the IMD exclusion. Furthermore, because the IMD exclusion is largely inapplicable to hospitals where less than 50 percent of patients are admitted as a result of a mental disorder, we are concerned that the newly eligible Medicaid population will be forced to seek expensive hospital-based SUD treatment rather than the more cost-effective and clinically appropriate community-based residential SUD care.

There are several legislative and regulatory proposals currently afloat that address the IMD issue.

REGULATORY PROPOSALS

Earlier this year, the Center for Medicare and Medicaid Services (CMS) proposed a rule change that would somewhat impact services that could be provided at an IMD. The proposed rule would allow for a capitated payment to provide crisis residential services to enrollees in an IMD for up to fifteen days in a calendar month. It states only that these payments may be made “so long as the facility is an inpatient hospital facility or a subacute facility providing crisis residential services, and the length of stay in the IMD is for a short-term stay of no more than fifteen days during the period of the monthly capitation payment” (2015).

The proposed rule states that the fifteenday limit was chosen based on data from the Emergency Psychiatric Demonstration under the Affordable Care Act (ACA). That demonstration was limited to patients with severe psychiatric needs, so there is no data from the demonstration to suggest that fifteen days would be appropriate for a typical SUD patient in need of those services. Currently, Medicaid covers no stay of any length for any reason in an IMD. This proposed rule is a small step forward. The term “acute,” however, is not well defined, and there could be be some confusion as to what services qualify as acute care.

In July of 2015, CMS issued a letter to the

state Medicaid directors, encouraging them to take advantage of regulatory measures in place that would allow them to explore options to increase the number of patients treated by IMDs. Section 1115 demonstration projects allow states to test innovative policy and delivery approaches that promote the objectives of the Medicaid program. States may receive federal financial participation (FFP) for costs not otherwise matchable, such as services delivered to targeted populations, in limited geographic areas or in settings that are not otherwise covered under the Medicaid program.

CMS also recently launched the Medicaid Innovation Accelerator Program. The Innovation Accelerator Program supports state efforts to accelerate Medicaid innovations by offering technical assistance and expert resources to states engaged in Medicaid system redesign efforts.

Based on work with states and stakeholders, CMS identified SUDs as the first area of focus for the Innovation Accelerator Program. As part of a strategy to improve the care and health outcomes and reduce costs for individuals with a SUD, CMS has begun engaging states to leverage Innovation Accelerator Program resources to introduce system reforms that better identify individuals with a SUD, expand coverage for effective treatment, and enhance practices to effectively treat beneficiaries.

In an effort to alleviate the problems caused by the IMD exclusion, the state of California applied to CMS for a Section 1115 waiver.

This waiver, while a very effective temporary solution, is exactly that—temporary. It is only in place for four years, and took almost three years to implement. The consumers of substance abuse treatment services need a permanent solution to this problem, not simply a stop-gap measure.

LEGISLATIVE PROPOSALS

The Breaking Addiction Act of 2015 (HR 1988) was introduced in late April 2015 by Representatives Marcia Fudge, Tim Ryan, and Marcy Kaptur, all Democrats from Ohio. The same trio introduced The Breaking Addiction Act of 2014, but this year’s version is quite different. In the previous version of the act,

Mar/Apr 2016 the Secretary of Health and Human Services (HHS) would have sought to establish a fiveyear demonstration project under which payment may be made to each participating state for any medical assistance provided with respect to a qualified individual being treated for a substance use condition in a community-based institution for mental diseases. This year, the bill’s sole purpose is to support and enhance the 1115 waiver options available to states for residential substance use care. The bill seeks to increase states’ flexibility under their Medicaid programs to cover SUD services provided in IMDs. Current law prohibits Medicaid from paying for residential or inpatient services provided to individuals in facilities of more than sixteen beds that are engaged primarily in treating those with mental health and substance use conditions. As a result, states cannot receive federal Medicaid funds for most residential substance use care, and patients in need are left without access to services.

The Act, if passed, would direct the Secretary of Health and Human Services to accept Medicaid Section 1115 waiver applications from states looking to provide medical assistance to individuals seeking treatment for substance abuse in community-based IMDs, defined in the legislation as IMDs with no more than sixty beds. In simplest terms, the bill seeks to allow states to apply for a waiver that would allow them to expand from a maximum of sixteen inpatient beds to the aforementioned sixty. It would also direct the Secretary to report on the results of such waivers and provide a recommendation as to whether the waiver of the IMD exclusion should be expanded and made permanent. CMS already has the authority to selectively waive the IMD through Section 1115 waivers, yet it has had a practice for many years not to exercise such discretion. Last year, CMS announced that it would approve a limited number of Medicaid Section 1115 waivers for short-term residential substance use care. Under the Breaking Addiction Act, CMS would be required to approve all such waiver applications.

However bold a step the Breaking Addiction Act may be, even if passed it does not solve all of our problems with the IMD issue. Primarily, the ball remains in the court of the states, as the onus will be on them not only to apply for 1115 waivers, but to design them in such a way that the number of beds in a residential treatment facility can expand to the number allowable by the act. The IMD exclusion is a faulty federal rule, which in the end will require a federal fix. It should also be noted that the prospects for passage are quite slim. Between

a legislative calendar that is all but stalled, and a bill that deals with an issue as complex as Medicaid, the pace will be extremely slow.

Another bill that touches upon the issue is Representative Tim Murphy’s Helping Families in Mental Health Crisis Act (HR 2646).

The original version, drafted earlier this year, included language that would withdraw the IMD exclusion, with a caveat: it would only go into effect if CMS were to certify the change would not increase net spending. This was an impossible proposition, as the cost of such a measure would be billions of dollars. Granted, money could be saved in the end via the investment in treatment, but initial spending must take place first. In November 2015, a new version of the bill was introduced without this language. However, an amendment was introduced and accepted that incorporated the aforementioned proposed Medicaid rule change into the legislation.

During the 114th Congress, CCAPP has been a vocal supporter of the Comprehensive Addiction Recovery Act (CARA). The bill, which addresses a variety of issues in addiction treatment, especially in the criminal justice system, has wide bipartisan support. The original version of the bill, first written in 2014, made no mention of the IMD exclusion. Yet tucked into the back of the rewritten bill—literally on its final page—there is a provision that would help us gain some ground in the reform of the IMD. At the request of CCAPP and others, the bill calls for the submission to Congress of a report on the impact that the IMD has on access to treatment for individuals with SUDs. The report shall include an analysis of whether the following policy changes to the IMD exclusion would enhance access to treatment for individuals with a substance use disorder, and the viability of three potential options: • •Removing SUD treatment and facilities from the Medicaid IMD exclusion • •Amending Section 1905(i) of the Social Security Act (42 USC 1396d(i)) to modestly raise the sixteen-bed limit in the definition of an institution for mental diseases under that section • •Repealing the Medicaid IMD exclusion outright In addition, the bill calls for an analysis of whether and to what extent the quality of care for substance use disorder treatment is impacted by the IMD; an analysis of barriers in accessing State-specific information related to the impact of the IMD exclusion on access to treatment; an analysis of the difference in

Industry Insider 13

cost between treatment for SUDs in a hospital setting compared to a community-based care setting; and finally, an analysis of the characteristics of IMDs. Between the regulatory and legislative proposals currently afloat, progress on the issue is certainly being made. Yet until access to treatment is improved, and regulations such as these remain in place, our treatment system will never be truly effective. As we move further into 2016, and the conversation on substance abuse policy continues, we are hopeful that the IMD exclusion will be reformed in the very near future. ■ Andrew D. Kessler, JD, is founder and principal of Slingshot Solutions LLC, a consulting firm that specializes in behavioral health policy and Federal Policy Liaison for IC&RC. IC&RC promotes public protection by setting standards and developing examinations for credentialing prevention, substance use treatment, and recovery professionals.

References The Medicaid and CHIP Managed Care Proposed Rule, CMS-2390-P (2015).

Substance Abuse and Mental Health Services Administration (SAMHSA). (2008). Substance abuse prevention dollars and cents: A cost-benefit analysis. Retrieved from http://www. samhsa.gov/sites/default/files/cost-benefits-prevention.pdf The Social Security Act, 42 USC §1396d (2003).

14 Industry Insider

Mar/Apr 2016

Evolve: “Watch Us Grow” The tagline for Evolve Treatment Centers’ comprehensive, strengthbased, and solution-focused treatment program tailored specifically for teens struggling with addiction, mental health, and behavioral issues is “Grow with Us.” However, the tagline could very well be “Watch Us Grow.” In just over a year since opening the doors of their first teen outpatient program in Bel Air, California, Evolve has expanded exponentially.

The initial staff of ten has grown to 180 to support the opening of an additional four teen treatment facilities, two Jewish community outpatient programs, an outpatient program for emerging adults aged eighteen to thirty-five, a community awareness/prevention program, and an international campaign dedicated to giving teens and young adults an online and social media platform to be heard without judgment.

The vision, drive, and energy that has turned Evolve Treatment Centers into a leader in teen treatment, advocacy, education, and prevention, stems from its CEO and cofounder, Mendi Baron.

Baron, a licensed social worker who happens to also be the son of a rabbi, the eldest of eleven children, a part-time rock musician, a cantor, and a father of two, is the confident and determined force behind Evolve. A passionate advocate for teens, Baron’s extensive clinical experience as a therapist includes individual and group counseling for children, adolescents, and families in various settings. He has worked at several treatment centers, including Chesapeake Center for

Youth Development, Carroll County Youth Services Bureau, Chabad Crisis Centers, and the Center for Discovery and Adolescent Change.

It was at the Center for Discovery that Baron met Gryphon Ward, COO and cofounder of Evolve. A seed was planted that day, which grew into the reality that is now Evolve. Since the fall of 2014, Baron and Ward have successfully opened five innovative and cutting-edge teen treatment programs— Sunset Hill in Agoura Hills, Mountain View in Ojai, Birch Creek in Agoura Hills, Griffin Oaks in Ojai, and Sky Crest in Topanga.

On the horizon are two additional facilities in the San Fernando Valley.

Last January, Baron launched The Jewish Community Program by Evolve to provide the full array of treatment methodologies to Jewish families, teens, children, and individuals struggling with mental health, addiction, and/or behavioral issues with the support of a team of professionals from within the observant Jewish community who are sensitive to this community’s specific spiritual and cultural observance. Last summer, Baron further broadened Evolve’s reach by opening Bel Air Treatment by Evolve, an outpatient program for emerging adults struggling with mental health, addiction, and/or behavioral issues.

Evolve’s mission extends beyond treatment. With the Saving Lives

by Evolve program and the Can You Hear Me? Campaign, Evolve is already making an impact in advocacy, education, and prevention. ■

TPAS: Treatment Professionals Harness the Power of Collaboration Lorie Obernauer, PhD, & Keith Gallant the growing membership of Treatment Professionals in Alumni Services (TPAS), a group of treatment and recovery professionals helping one another succeed in improving outcomes for alumni and all people in recovery.

The idea for TPAS was conceived by a small group of intensely passionate professionals who wanted to learn more, and share more, about successful recovery support practices. Informal phone calls evolved into regularly scheduled conference calls, eventually morphing into biannual meetings with professionals across the United States.

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f ever you wanted to put together a surefire recipe for failure, ignoring your most valuable resources would be a darn good strategy. Conversely, to meet a formidable challenge—like delivering highquality support for people recovering from the disease of addiction—the best approach comes from leveraging the knowledge and experience of every bright mind working in this part of our industry. This is the mindset that motivates

WHAT’S A COLLABORATIVE?

TPAS national gatherings are called “Collaboratives.” Like other industry conferences, Collaboratives are held primarily for the purposes of networking and education, but the similarities stop there. TPAS Collaboratives employ a workshop tool called “Open Space Technology,” developed by Harrison Owen, which empowers each participant to behave as a teacher, student, director or contributor

at any given moment.

Breakout sessions at Collaboratives are determined collectively. Participants submit, via sticky note on whiteboard, a presentation that they’d like to give based upon their unique talents or experiences. The group may choose to combine like-minded presentations, turning the presentation owners into coleaders of a newly minted session. Where individuals choose to spend their time during breakout sessions is governed by the “Law of Two Feet,” which dictates that “If during our time together, you find yourself in any situation where you are not learning or contributing, use your two feet and go to a more productive place.”

Participation in Collaborative breakout sessions is also guided by four principals: whoever comes are the right people; whatever happens is the only thing that could have; whenever it starts is the right time; and when it’s over, it’s over.

A PROCESS FOR CHANGE

If the TPAS Collaborative process sounds like a highly creative and loosely structured

Mar/Apr 2016 event, that’s because it is, by design. Our organization’s leaders believe wholeheartedly that finding new solutions requires a new approach. The status quo in the addiction treatment industry is for each company to work independently, competing fiercely with one another, and succeeding by way of another’s failing. Meanwhile, our nation faces an enormous challenge to productively support people in recovery and it’s time for a change. TPAS

is changing this reality, and our members are prepared to do everything differently if that’s what works best.

Members of TPAS speak of Collaboratives in similar terms to those used in describing the Burning Man festival—words like “enlightening” and “transformational” are the norm, rather than the exception. TPAS is an organization comprised of people who deal with life and death outcomes as a regular part of their work. To be

Industry Insider 15

part of a group where we can share our challenges and successes—and define best practices for the industry—is of tremendous value.

That’s why TPAS is here to stay and we will succeed in improving outcomes for alumni and all others in recovery together. To learn more, visit www.tpasrecovery.org. To fully experience the wonders of TPAS, join us at the 2016 Spring Collaborative. ■

Catasys Signs National Deal with Humana to Provide Addiction Care Management

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n November 24, 2015, Catasys, Inc. announced it had signed a national agreement with Humana Behavioral Health to provide its OnTrak specialty addiction treatment management program nationwide to Humana’s commercial and Medicare members with substance use disorders (SUDs) and co-occurring chronic medical conditions. The program, branded as OnTrak-h, will provide medical and psychosocial intervention services over a fifty-two-week period, as well as a telephonic care coaching component. Humana had previously offered access to OnTrak-h to members in Florida, Kentucky, and West Virginia. The national expansion to all fifty states, the District of Columbia, and Puerto Rico began during the last quarter of 2015. The program uses claims-based analytics to identify Humana members at risk for medical and psychiatric complications of substance abuse and proactively engages them in outpatient treatment and care coaching lasting fiftytwo weeks. The program integrates physician visits and visits for psychosocial interventions for addiction disorder, such as motivational enhancement therapy and cognitive behavioral therapy, plus telephonic care coaching.

In April 2015, researchers with Humana and Catasys reported that Humana members enrolled in a pilot OnTrak deployment had average overall health care costs 46 percent lower than the year before they entered the program. Costs for a comparison group of Humana members with addiction disorder who did not participate in the OnTrak program increased an average of 12 percent over the previous year. The study compared outcomes for 151 Humana members who participated in OnTrak and 2,198 matched nonparticipants, also Humana members, who all had a medical claims history of SUDs and an elevated claims threshold (defined as “impactable”

costs of $7,500 or higher). The study excluded Humana members with SUDs and high claims costs who also had other high-cost chronic conditions such as schizophrenia, HIV/AIDS, dementia, cancer or who had or gone through a transplant. The participants were matched to eligible nonparticipants based on a score from an algorithm used to estimate medical condition severity and functionality. For the study, the researchers used participant claims data to compare changes in the number of emergency room visits and inpatient admissions per person before and after participation in the OnTrak program. Costs were reported as changes in average allowed claims costs per member per month (PMPM) for both the participant and nonparticipant groups.

ADDITIONAL DETAILS AND FINDINGS

Humana and Catasys enrolled 17.6 percent of members offered the program. They conducted population-based proactive outreach with the target population of members with an SUD diagnosis and high claims costs.

The outreach consisted of a monthly outreach letter and three telephone calls per month.

Nationally, about 10 percent of people with addiction disorder enter treatment.

While enrolled in the program, the OnTrak participants had 16 percent fewer emergency room visits and 67 percent fewer inpatient hospitalizations than the year before beginning the program. For those who were hospitalized, the length of stay decreased by 15 percent. The number of prescriptions per person dropped by 10 percent.

In the year before the study started, average PMPM costs for the participants averaged $10,792 and averaged $8,078 for the nonparticipants. By the end of the study period, the participants’ PMPM costs had dropped by

43 percent from $10,792 to $6,081. The nonparticipants’ average PMPM costs increased by 12 percent from $8,078 to $9,030.

ABOUT HUMANA AND CATASYS

Humana Behavioral Health is a subsidiary of Humana, Inc., which offers commercial and Medicare plans. Humana has 14.2 million medical members across the United States and Puerto Rico, which includes 3.2 million Medicare Advantage members and 4.5 million Medicare Part D prescription plan members. Annual revenue for 2014 was reported at $48.5 billion.

Catasys, Inc. provides specialty health management services for health plans. Catasys currently operates programs in Florida, Illinois, Kansas, Kentucky, Louisiana, Massachusetts, Missouri, New Jersey, Oklahoma, Pennsylvania, West Virginia, and Wisconsin. For the nine months ended on September 30, 2015, Catasys reported $1.4 million in revenue and a net loss of $8.3 million. The loss was attributed to increases in general and administrative expenses and to the higher cost of health care services based on increasing enrollment and noncash general and administrative expenses. The increase in general and administrative expenses was attributed to noncash compensation expense for stock option grants to the members of the board of directors.

OPEN MINDS reported on the study findings in “Humana Reports Population Health Management Approach Using Catasys Addiction Program Cut Participant Costs By 46 Percent,” which was published on June 7, 2015. ■ Source: https://www.openminds.com/marketintelligence/news/catasys-signs-deal-with-humana-toprovide-substance-abuse-care-management.htm/