The changing healthcare landscape: tools for states and treatment providers

June 11, 2015
Todd Molfenter, PhD

Senior Scientist, Center for Health Enhancement Systems Studies

Co-Deputy Director, NIATx

In this time of health system reform, states have had to plan for and implement dramatic changes, particularly in the way they purchase and provide addiction treatment services. The unprecedented amount of change has compromised states’ abilities to provide the full spectrum of technical assistance that addiction treatment programs may need to adapt to the changing environment (see Andrews et al., Health Affairs, 2015).

For the past several years, NIATx has led a range of SAMHSA-funded projects designed to help states make the transition to this new landscape. Lessons from earlier NIATx projects such STAR-SI and Advancing Recovery have helped inform these state-based initiatives. A recurring theme in the earlier projects was the key role that state purchasers of addiction treatment services play. That remains true with our current efforts. What we’re finding in our work is a set of competencies that states can develop to increase the viability of their publicly-funded addiction treatment systems.

Some states and treatment providers are focusing on administrative operations through SAMHSA’s BHBusiness Plus and other programs. The Strategic Provider Partnerships collaborative that we're now working on as part of BHBusiness Plus is helping three states (Texas, Louisiana, and Mississippi) look at ways to strengthen their addiction treatment systems at both policy and service delivery levels. Other states (like Ohio and Missouri, to mention just two)  are focusing on use of evidence-based practices such as medication-assisted therapy to reduce the impact of opioid misuse. Through these efforts, it’s become increasingly clear that states want evidence of improved treatment access and clinical quality, regardless of their ACA status or how they pay for substance use disorder (SUD) services.

At the provider level many efforts are, or should be occurring, that states may or may not be able to support with technical assistance. These efforts start with better access to treatment for SUDs. As a recent news stories reported, people seeking help for an SUD continue to encounter barriers to treatment. With improving access, we’re talking about reducing wait times and adding weekend and evening hours, or open access. Improving access also involves helping people get connected to health insurance that will cover their treatment.

Another driving quality indicator within the context of the ACA is documented use of evidence-based practices that are supported by better retention and completion rates.

Ultimately, ensuring treatment agency viability will likely rely on their ability to engage third-party payers to pay for treatment services. This, in turn, is driving treatment agencies to hire staff who meet requirements for insurance reimbursement. Earning accreditation from organizations such as The Joint Commission or CARF International has also become a quality improvement priority for many treatment organizations. 
There are many instances of states supporting the adoption and proliferation of these competencies that improve access and quality. At the same time, providers are also pursuing these capabilities on their own through the many training and technical assistance tools that NIATx and the ATTC Network offer.

What has your state or treatment organization been doing to adapt to the changing healthcare environment?  Let us know in the comment section below. 

Todd Molfenter, PhD, is Deputy Director of NIATx and a Senior Scientist at the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. He is currently a principal investigator for an NIH study focused on increasing use of buprenorphine in Ohio. Todd has led a variety of statewide projects designed to improve addiction treatment access and quality through system and organizational change efforts.  You can reach Todd at

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