If timing is everything, then there is no time like the present to start or expand outpatient addiction treatment services. At this point in time, there are significant regulatory and care delivery forces at work that are changing the face of addiction treatment and creating unique opportunities to develop quality, comprehensive, cost-effective treatment in the patient’s home community.

Insurance Coverage Drivers

Mental Health Parity and Addiction Equity Act

This law went into effect for most insurance plans in 2010 and requires larger employer-based insurance plans to cover substance use disorders in the same way they cover cancer or multiple sclerosis.  While insurers resisted this new law fearing cost increases, implementation showed negligible impact. It is estimated 30.4 million currently have some substance abuse benefits from the federal parity law.

The Affordable Care Act

In 2014, the ACA put in place comprehensive reforms that make insurance available to more people and enhance the quality of care. The ACA includes substance use disorders as one of the ten elements of essential health benefits. This means all health insurance must include coverage. It is estimated that one tenth (2.3 million) of the 23 million suffering from addiction currently receive any type of treatment.

Parity + ACA = Addiction Treatment Insurance for 62 Million

In total, the ACA will insure 32.1 million that includes substance use disorder benefits and an additional 30.4 million who currently have employer-supplied insurance benefit from the federal parity protections.  By building on the structure of the Mental Health Parity and Addiction Equity Act, the Affordable Care Act will extend federal parity protections to 62 million Americans.

Care Delivery Drivers

Addiction Is a Chronic Disease

Ongoing research into substance abuse disorders has led to a major shift in how addiction is understood and treated.  It is now known and accepted that addiction is a chronic, recurring disease that can be successfully managed in much the same way diabetes is handled – regular visits to care providers, lab testing, behavior modification, and medication if/when needed.

Innovative Medications to Treat Addiction

While addiction treatment has historically relied solely on behavioral interventions, the availability of new medications to treat addiction alcohol, opioids, and nicotine that are able to be administered in an outpatient setting has made care delivery possible to many more patients than ever before. It is now possible to provide quality care for an extended period of time at a fraction of the cost of acute, inpatient care.

Advances in Addiction Medicine Reposition Optimal Care to Outpatient Setting

Given the new understanding of what addiction is and how it can best be managed, the ACA defines  substance abuse treatment as part of primary care, where chronic diseases are best managed by focusing on earlier intervention, outpatient treatments, ambulatory care, and prevention.  Insurance companies are already developing standards for full-service outpatient systems that meet their subscriber’s needs.

MTC Enables You to Act Now
When large populations of undertreated patients are covered by insurance and services can be accessed in their own communities on an outpatient basis, the opportunities presented to clinical entrepreneurs are significant. Manifest Treatment Consulting, LLC exists to guide and support those who have an interest in addiction or medicine or helping their neighbors to own and operate their own outpatient treatment services. Starting up or expanding an outpatient treatment program from scratch could be overwhelming but with MTC it becomes possible.