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Addressing Addiction and Substance Use in National Health Reform

Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center. Addressing Addiction and Substance Use in National Health Reform. Eric Goplerud, Ph.D. Alliance for Health Care Reform July 17, 2009.

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Addressing Addiction and Substance Use in National Health Reform

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  1. Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center Addressing Addiction and Substance Use in National Health Reform Eric Goplerud, Ph.D. Alliance for Health Care Reform July 17, 2009

  2. Identification Rates for Substance Use Disorders and Other Common Health Conditions What percentage of affected individuals are identified?

  3. Substance Use Screening and Treatment is grounded in good science THE NATIONAL QUALITY FORUM September 2007 Consensus Standards for Substance Use Treatment

  4. Substance Use Treatment Reduces Medicaid Costs Wickizer, T.M., A. Krupski, et al. (2006). “The effect of substance abuse treatment on Medicaid expenditures among GA clients in WA State.” Milbank Quarterly, 84(3): 555-76.

  5. Substance Use Treatment Reduces Employer and Employee Health Care Costs Parthasarathy, Weisner, Hu and Moore. “Association of Outpatient Alcohol and Drug Treatment with Health Care utilization and cost: Revisiting the Offset Hypothesis.” Journal of Studies on Alcohol. (2002): 89-97.

  6. Fleming, Mundt, French, Manwell, Stauffacher, and Barry. “Brief Physician Advice for Problem Drinkers: Long-Term Efficacy and Benefit-Cost Analysis.” Alcoholism: Clinical and Experimental Research. (2002): 36-43.

  7. Cost Effectiveness of Alcohol Screening and Brief Intervention • Estimated net health savings of $254 per person offered screening • $1,755 per Quality Adjusted Life Year (QALY) saved in health care costs • In top 4 most cost-effective US Preventive Service Task Force recommendations • Discuss daily aspirin use: men 40+, women 50+ • Childhood immunizations • Smoking cessation advice and help to quit – adults • Alcohol screening and brief counseling – adults Solberg LI, et al. Primary care intervention to reduce alcohol misuse: ranking its health impact and cost-effectiveness. Am J Prev Med. 2008;34(2)

  8. Addiction and National Health Reform:Application to the Tri-Committee and HELP bills • Benefit Design – + Parity: Equitable and full coverage for treatment of substance use disorders + Universal coverage: Persons with MI and SA twice as likely to be uninsured, so extension of coverage to individual and small group markets is essential + Medication assisted treatment: Inclusion in drug discount program (340b) - Addiction recovery supports: Not specifically included in patient centered medical home

  9. Addiction and National Health Reform:Application to the Tri-Committee and HELP bills • Prevention – - No explicit inclusion of substance use prevention and mental health promotion to wellness and prevention. - No explicit inclusion of substance use prevention, screening or treatment in school-based health programs Workforce Infrastructure – -No explicit inclusion of addictions professionals in health care workforce programs. - No explicit inclusion of substance use in training of primary care workforce.

  10. Center for Integrated Behavioral Health Policy Department of Health Policy, The George Washington University Medical Center Eric Goplerud, Ph.D. Director 2021 K St. NW, Suite 800 Washington, DC goplerud@gwu.edu integratedbehavioralhealth .org

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