No Rush for Addiction Treatment Services in Wake of Healthcare Reform: Oregon Study

Despite predictions that healthcare reform would greatly increase the number of people seeking drug and alcohol treatment, a new study conducted in Oregon suggests so far, no big changes are occurring in that state.

“We’re not seeing any upticks in the number of people with drug or alcohol diagnoses, or changes in access to medications to treat alcohol and drug disorders,” says Dennis McCarty, PhD, Professor in the Department of Public Health and Preventive Medicine at Oregon Health Sciences University in Portland.

McCarty, Principal Investigator for the Western States Node of the National Drug Abuse Treatment Clinical Trials Network, presented his findings at the recent American Psychological Association annual meeting.

“So far, while healthcare reform is moving forward, it’s business as usual for drug and alcohol treatment programs in Oregon,” McCarty said. “We’re not seeing any big changes in how the programs are delivered.”

The study is using Medicaid data to assess changes in access to care, changes in medications and the use of emergency and inpatient care related to drug and alcohol disorders. McCarty and colleagues looked at data from 2010 to the first half of 2013.

Oregon is an especially good state in which to study healthcare reforms, McCarty said. The state’s Medicaid plan, called Care Oregon, transitioned to 16 regional networks of healthcare providers called coordinated care organizations (CCO), each of which receives a budget that covers medical, behavioral and dental care. The largest CCO has more than 200,000 members in Portland, while smaller organizations have 20,000 members in more rural areas.

One of the indicators in the study was how many people received screening, brief intervention and referral to treatment (SBIRT) for alcohol problems. “The rate statewide is about two percent of patients screen positive for an alcohol or drug use problem,” McCarty said. “Oregon requires health plans to screen and do brief interventions on all members when appropriate, but those programs haven’t been well developed. CCOs have struggled with it. As they begin to do a better job of screening, I expect to see more demand for alcohol and drug treatment services.” In fact, during the last six months, clinics adjusted their workflows and improved the overall screening rate to three percent. Some CCOs exceeded five percent rates for positive screens.

He is not surprised by the slow progress so far. “Change is difficult,” he said. “We work with patients who need to change, so we understand how many patients struggle with change and we tend to forget many treatment programs struggle with change as well.” The need for more progress is great, he added. “Healthcare reform offers a tremendous opportunity to better integrate addiction treatment services with primary care – it’s a shame to miss that opportunity just to keep doing things the way we’ve always done things.”

Under the Affordable Care Act, more than 340,000 people were added to the Oregon Health Plan in January 2014, McCarty said. “Our interviews suggest the new members were largely seeking help for untreated injuries like back problems,” he said. “We know from the National Survey on Drug Use and Health that 23 million Americans meet the criteria for drug and alcohol problems, but only three million seek help. The vast majority do not seek care, and so far, in Oregon that hasn’t changed even with healthcare reform.”

The state is making investments in reorganizing the delivery of care. One of the major changes has been that funding for mental health services is now integrated with primary care services. “The healthcare system does a poor job of identifying and treating drug and alcohol abuse and linking people to specialty care,” he says. “Drug and alcohol treatment specialists need to do a better job of introducing themselves to primary care settings and linking with them.”

He notes that of the people who receive medical detoxification services, only about 25 percent show up in ongoing care. “It’s a waste of services, and a failure to link with the addiction treatment system. We need to move away from 30-day treatment programs. That system doesn’t work. Some people do need the residential system, but we need to focus on the chronic care model, not the acute care model.”