There is a new world of healthcare delivery on the horizon. But how many understand how the looming changes introduced under healthcare reform will impact their organizations directly?
According to Michael Miller, MD, FASAM, FAPA, medical director of Herrington Recovery Center, Rogers Memorial Hospital, the answers have been overly complicated due to the fact that “we live in an extremely bizarre, highly polarized political climate.”
“We see it not only nationally, but also how it all translates locally,” explained Miller, who gave a presentation at the 2011 National Conference on Addiction Disorders (NCAD) titled “What Healthcare Reform and Primary Care/Addiction Care Integration Means for Treatment Providers.”
“Due to partisanship, the country is split 50/50. Half the country says we’re a community and we need to pull together, while the other half believes in individualism and wants the government to stay out of their lives,” he said.
Miller, a past president of the American Society of Addiction Medicine (ASAM) and one of the 2011 recipients of Addiction Professional’s Outstanding Clinicians Awards, addressed the numerous changes taking place, including the push to move addiction care out of a “specialty” setting and into primary medical care set forth in the Affordable Care Act.
“It consciously tries to bring addiction care into primary care medical centers,” he explained. “Primary care treats most depression, hypertension and some cancers, so it also should carry the bulk of identification and treatment for substance use and mental health disorders.”
Miller said that while delivery systems should include specialists for special cases, basic cases should go to primary care. But is primary care ready for that?
“They are positively not ready. They know it, we know it, everyone knows it,” said Miller. “But the conceptual framing is that it’s the way to solve the problem in an affordable way. And that’s an important message.”
Another important message involved accountable care organizations (ACOs), which Miller explained as a tool to shift risk from Medicare to provider systems.
“The idea is not only to create these organizations and give it a fee for taking care of a case, but also to impose data and quality requirements to demonstrate outcomes,” Miller explained.
In regard to the perceived timeframe for which ACOs will impact most organizations, Miller believes that in reality, it might be a while.
“ACOs impacting psychiatrists in addiction care is not going to happen tomorrow, or even next year,” he said. “And it may even be a number of years because it isn’t even really conceptualized yet. But the concept is coming.”