By: Karina Gonzalez
ASAM and announced a collaborative effort with Brandeis University to test and validate three ASAM performance measures for addictions treatment. ASAM hopes that this project will provide measure testing of performance measures that will be accepted and adopted in the treatment of patients with addiction.
Three measures will be tested using two years of de-identified Cigna claims data for substance abuse. The measures to be tested in the study will be: use of pharmacotherapy for individuals with alcohol use disorders; pharmacotherapy for individuals with opioid use disorders and follow-up after withdrawal. This is expected to be a six month project.
Health insurers have captured large amounts of information within their claims databases which in this project will be used by researchers in examining clinical performance measures for treating addiction. According to experts, the project is significant because it is the first to leverage insurance claims to look for evidence to identify addiction treatment best practices. Outcomes is one thing, but the only way to truly drive best practices is to identify specific clinical actions that lead to optimal outcomes so those actions can be broadly implemented across all providers”, says Corey Waller, who chairs ASAM’s performance measures committee.
Cigna’s chief medical officer for behavioral health, says the huge variation in addiction treatment care delivery across the country combined with the lack of standard quality measures make it difficult to assess the ultimate value of the services.
South Florida substance abuse providers have been hit with large amounts of audit activity from Cigna and other healthcare payors. They have faced large overpayment demands because of claims that they have not engaged in best practices as stated by the commercial insurers. Therefore, more evidence based clinical bench marks and clearer understanding of what is being measured and a better set of criteria for the value of care is a step in the right direction.