Parity to Bring Change and Opportunity

Changes brought on by two federal acts will bring immense opportunities for addiction medicine specialists to practice in holistic ways for the benefit of Americans needing treatment.

The possible upshot and positive outcomes of the Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act, were addressed Thursday evening during Component Session VII, “Parity and Health Care Reform: Changing the Way Addiction Treatment Providers Do Business.” Summarizing the major issues discussed during this session was moderator A. Kenison Roy, III, M.D., FASAM, founder and Medical Director of Addiction Recovery Resources Inc., New Orleans.

“The main sense of what we talked about is that change is coming,” he said. “The practice of medicine, particularly addiction medicine, will not be the same. The opportunity is for us to resume the role and function of physicians to lead, teach, and manage the treatment of patients with addiction.”

Newer models of addiction medicine will no longer involve just seeing one patient right after the other as the practice has often been for many addiction specialists. The older model restricted these physicians to the one-dimensional prescription practice rather than the holistic patient care model, Dr. Roy said. The new role will evolve to include a nice mix of responsibilities — partly team manager, partly team leader, and partly face-to-face patient care.

The newer models will expand opportunities for physicians to participate in ways unlike ever before and will include structures, such as the patient-centered medical home, accountable care organizations, and larger groups formed by independent practice associations of smaller practices. Dr. Roy said these new models would be part of relationships being incentivized with hospitals and a wider spectrum of the health care delivery system to integrate addiction care in every aspect of that whole spectrum. The newer models will also require the use of electronic health records, new payment and delivery models, new billing and reimbursement practices, and quality reporting bonus payments.

“There are millions more patients who will not only have resources for care, but also be educated that they need the care,” he said. “It is a recognition that it is a rare addiction patient who doesn’t have medical and psychiatric co-morbidities. Those co-morbidities need to be identified and medically addressed, not to mention the fact that addiction in (and of) itself is a medical illness that needs to be managed by physicians.”

The newer models will actually save money by addressing illness (addiction) that has previously gone unrecognized or untreated, which has driven up health care costs rather than kept them down, Dr. Roy said. Historically, insurance companies have functioned in silos and consequently sought to reduce costs simply through lack of treatment of addiction or other illnesses. By integrating addiction care through the spectrum of medicine, current estimates are that this move will reduce insurance costs by $55 per person each month.

With new regulations pending and the passage of parity, addiction medicine will be on a different playing field, he said.

“The recommendations that came out of this session were for physicians in addiction medicine to be proactive in this process, to think it through, and to be deliberative,” Dr. Roy said. “The more we advocate for our patients, the more healthy our business plan will be.”