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Foreword of TAP 16: Purchasing Managed Care Services for Alcohol and Other Drug Treatment: Essential Issues and Policy Issues

Foreword

Today, the U.S. health care system is undergoing a period of rapid change that will profoundly affect how alcohol and other drug (AOD) treatment is funded and delivered. Our AOD treatment systems are changing fast, as substance abuse treatment is increasingly being provided through managed care arrangements. More than 30 States are actively involved in health care reform plans, many of which include efforts to treat publicly funded AOD clients through managed care initiatives. This move to managed care creates tremendous challenges for both State substance abuse agencies and for local treatment providers, who all need to be ready to function well in this new, more competitive environment.

Managed care promises many positive benefits, from cost savings to increased focus on outcomes and on providing appropriate treatment that is targeted to each individual's need. But the change to managed care also carries very significant risks for our clients in the publicly funded system—people who are often poor, have little political clout, and have serious needs and problems not typically covered in private managed care plans.

Managed care is essentially a system for providing acute care, while substance abuse is a complex, chronic, and recurring condition. The length and intensity of treatment are both important for successful recovery of those with AOD problems. Many managed care organizations have little experience with AOD treatment among populations like ours, with their challenging and comprehensive long-term needs.

Another serious risk is that managed care plans could exclude current AOD treatment providers, who are experienced with these difficult populations but may lack the infrastructure and the resources required by managed care organizations (MCOs). These providers, who have worked long and hard to provide services to poor and uninsured clients with multiple needs, deserve the opportunity to continue their services in this competitive new environment.

Nothing is more important at this particular time than the specific contract stipulations that will be made between the States and MCOs regarding AOD services. Personnel in State agencies will need to work through a wide range of issues as they prepare to purchase, manage, monitor, evaluate, and develop MCO standards for providing managed care services to those with AOD problems. Managed care initiatives need to be well designed, carefully developed, closely monitored, and strongly enforced.

States can do much to establish workable, positive contracts with managed care providers that will be comprehensive and equitable for all. Carefully developed contracts can benefit AOD clients now being served in the publicly funded system, as well as supporting our existing AOD treatment providers as they move into the new system. Such contracts can also provide for our particular concerns regarding these clients, including their need for ready access to care, for outreach, for adequate, long-term benefits, and for the special services needed by pregnant women, parolees and probationers, adolescents, and ethnic or cultural groups.

This document is intended to provide guidance to those in State AOD and Medicaid agencies who will be undertaking essential roles as planners and managers of managed care contracts. To address critical issues in this emerging area, the Center for Substance Abuse Treatment (CSAT) sought the advice and direction of a publication development panel made up of experts from States that are already well advanced in developing State managed care plans for AOD clients. The guidelines and recommendations presented in this document are the result of their efforts.

On behalf of CSAT, I wish to express my grateful appreciation to the publication development panel and its chair, Jeffrey N. Kushner, and to Stephen Moss, Ph.D., the consultant and writer. I also wish to extend special thanks to the many dedicated individuals who reviewed this document and provided their comments and expert advice.

The expertise of all of us working together will be neede das we learn to operate successfully in this new managed care environment and seek to preserve the right of publicly funded AOD clients to receive adequate, appropriate, and effective treatment. Within this context, CSAT is pleased to publish this document as part of our mission, in partnership with State and local governments and community-based programs, to imporve the access and effectiveness of addiction treatment and recovery services on a nationwide scale.

We hope this manual will encourage and guide State agencies and treatment providers as they take an active and influential role in shaping and managing our evolving health care system.

Susan L. Becker
Associate Director for State Programs
Center for Substance Abuse Treatment

Last Updated 11-7-02