Addiction & Hospital Utilization – The Endless Loop?

Executive Briefing | by | February 6, 2017


Monica E. Oss
Monica E. Oss

Recently we’ve had a lot of coverage of addiction in general, and opioid addiction in particular. These are just a few of the articles that we’ve published in the last 30 days:

One of the big costs of addiction isn’t the treatment itself. It’s the other medical expenses incurred by people with addictions (see Costs of Addiction). For example, employees with addiction cost twice as much as other employees (see Substance Use Disorders and the Role of the States); and alcohol-related injuries make up half emergency-room visits and the majority of hospital stays (see Shoveling Up II: The Impact of Substance Abuse On Federal, State & Local Budgets).

This disproportionate use of medical care by consumers with addictive disorders is part of the driver for integrated care coordination models like health homes and specialty medical homes. I covered these issues in my recent article, Opioid Addiction – The Crisis, The Impact & The Responses), which received many comments from our OPEN MINDS Circle subscribers – including Scot Adams, Vice President for Advancement at Notre Dame Sisters and the former director of Nebraska Department of Health and Human Services’ Division of Behavioral Health. Mr. Adams’ comment boiled down to one important question: Why don’t consumers with addiction get more referrals to addiction treatment when they use medical care? In our subsequent conversations, he made a few interesting points:

Mr. Adams

Why isn’t substance abuse more recognized and treated in typical health care settings? The impact that substance use has on mainstream health costs is one big reasons. For example 25% of general hospital beds are filled with persons being treated for effects of substance abuse, like overdose, but not the core issue – addiction. And that goes further [to include physical health care] with the standard practice at many emergency departments to “fix what’s in front of me” and ignore the rest. Or at best, refer it somewhere else. Value-based health care is helping this, however, that is more the payer’s hot ticket right now and less the provider organizations that are still working as they were trained. They are paid to fix the broken arm, but not to drill down about the cause – a drunken fall.

There is also “good ole denial” which comes in two versions. First, there is the generalized societal denial of addictive behavior, like obesity/food addiction; more traditional chemical and alcohol; pornography and sexual addictions; and co-dependencies to any of the above. This creates a culture in which such behaviors seem “normalized.” That is, addictive behaviors appear normal because it’s so prevalent.

Secondly, there is specialized denial that comes with encountering a person who is in a personalized love relationship with an unhealthy love object (alcohol, drugs, etc). This denial is specific to the person and his/her immediate network (including provider organizations) and causes others who might want to intervene to back away because “who needs that bark from a client?”

I also see change in our clinical language away from clarity about addictions to a blurry, combined reference to “substance use disorder.” While I applaud the intentions behind the simplifying of this to a singular label, as well as the effort to destigmatize addictions, I think those values come at a price of medical and social service professionals’ reluctance to identify dangerous behaviors – e.g. one can be in dangerous territory with drugs without being an addict, but professionals are reluctant to say so because they don’t want to wrongfully accuse someone of being an addict.

And lastly, among professionals working in the addictions field, there are still “old schoolers” who deny the value of medication-assisted treatment (MAT). Some of these professionals have never been trained in the specifics of addiction and think it’s just another mental health malady to add to the treatment plan. So much is in flux these days that anything – including data-based conclusions – are subject to wide variation across the country. It truly is a time of change and upheaval in so many ways.

My takeaway is that executives of provider organizations moving to value-based reimbursement will need a population health management approach that includes using medical care utilization as a “sentinel event” for initiating addiction treatment. But this will take more data sharing, better analytic tools, and new care coordination protocols.

To continue the conversation on the state of addiction treatment benefits, join me on June 6, 2017 at The OPEN MINDS Strategy & Innovation Institute where Jim Gargiulo, Senior Associate, OPEN MINDS will speak with addiction treatment provider organizations leading the way in the session, “The Shift From Residential: Keeping Up With The Changing Addiction Treatment Landscape.” For more, follow our coverage on Twitter @openmindseditor.

 


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