Get Ready Now for Influx of Patients Under Affordable Care Act, Expert Urges

Substance abuse treatment providers must take steps now to get ready for the influx of new patients they will begin to see in January 2014 as a result of the Affordable Care Act, according to an expert speaking at the National Conference on Addiction Disorders. Most behavioral health providers have not yet adequately begun to prepare for the “huge tsunami” of new patients, says Ron Manderscheid, PhD, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors.

“With the expansion of Medicaid and the state health insurance exchanges, a huge portion of newly enrolled patients will be people with behavioral health conditions—about 11 million of the newly enrolled 32 million,” says Manderscheid, who is also a professor at Johns Hopkins University in Baltimore. “At least 60 percent of those will come with primary substance use conditions, because they have been excluded from Medicaid for so long.”

The first step behavioral health organizations need to take to prepare for these new patients is to find out who they are, he says. “These people haven’t been at clinics—they’ve been treated in the emergency room, or they’ve been in jail,” he notes. “There’s a huge knowledge gap in the behavioral health field about this population.”

These new patients are not used to being treated in the clinic, and will need to be taught how to access care there. “In the past, we only turned on when someone had insurance—we were a downstream operation, and now we will become an upstream operation,” adds Manderscheid.

Under the Affordable Care Act, substance use treatment providers will be part of a “health home,” a team of professionals that provides integrated health care—from primary care to dental care to behavioral health care. Substance abuse treatment providers need to start working immediately to build and participate in health homes, he states.

Behavioral health organizations will also have to closely examine how they will have to change billing practices. Manderscheid explained that instead of billing for each individual service, organizations will move to a case rate, where they will be pre-paid a specified amount per patient to deliver a specific package of services over a set period of time. Rates are derived from projections of services and costs, based on historical claims of data. Payment does not vary based on the actual services provided to each member. “You get the money in advance, and if you burn up too much money, it’s your problem,” he says.

Manderscheid advises substance abuse treatment providers to appoint someone as a “strategy officer” to head up strategic planning in advance of 2014. Currently, he said, most providers are on their own in trying to get ready for health care reform changes, because there is not enough technical assistance available from the federal or state governments. “Most organizations are ill-prepared for the huge changes that are coming,” he emphasizes. “They need to plan for it right now.”