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Inaugural
Conference of the Wharton-TRI Center for Organization and Management in
Addiction Conducted November 2005 First-of-its-kind
Center Concentrates on Problems of Personnel, Funding and Stigma in the
“Business” of Addictions Treatment.
The Center for Organization
and Management in Addiction Treatment (COMAT), is a joint undertaking
between the Treatment Research Institute and the Wharton School at the
University of Pennsylvania. Made possible through funding from the Robert
Wood Johnson Foundation, at COMAT entrepreneurial and industry experts
partner with leading addictions researchers to evaluate the nation’s
treatment system as a “business,” one with the same disaffected
customer base, high rates of staff turnover, and overall malaise as other
once-struggling industries.
By analyzing lessons
learned in other problem-plagued industries, COMAT Co-Directors A. Thomas
McLellan, Ph.D. and John Kimberly, Ph.D. from Wharton, and their colleagues,
are working to develop and evaluate best “industry” practices
to reinvigorate the practice of addictions treatment.
First COMAT
Conference Convened November 2005
COMAT’s inaugural conference took place November 16 and 17, 2005
in Philadelphia, where approximately 30 researchers and industry and management
specialists gathered for a diagnostic appraisal of the addiction treatment
industry. By the end of the one and one-half days, consensus emerged around
the distinguishing characteristics of substance abuse treatment systems
that make change and performance improvement difficult to achieve:
- The
target consumers of substance abuse treatment services do not want services.
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Value is often experienced by people who are NOT the patient
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Almost all treatment programs are primarily funded by the public sector,
and funding patterns are not sensitive to performance but to political
imperatives
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Excessive regulation and bureaucracy impede quality improvement efforts.
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Not enough is known about value realized through investment of dollars.
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There is a seeming conflict between the medical/accreditation model
and the outcomes/expectations of the public.
Based upon these
assumptions, participants agreed that structural change in the way substance
abuse treatment is organized, financed, regulated and delivered is essential
for the “industry” to evolve into one with high standards
of quality and performance and ability to satisfy its “customers”
(patients) as well as public sector stakeholders (members of society,
their elected officials, and those who regulate the practice of addiction
treatment). Conference participants have agreed that a strategic plan
of action must be developed encompassing the following priorities:
- Encourage
performance-based reimbursement rewarding desirable outcomes and process
improvements under different financing and organizational arrangements
at a variety of levels (State, County, city, within city), and encourage
evaluation of results.
- Identify
opportunities and create incentives for consolidation of specific functions
for small treatment providers, e.g., back room activities, joint purchasing.
Similarly, identify opportunities for mergers among
small treatment providers that expand the variety of services that can
be provided within a single organization.
- Work with
States and Counties to create financial and administrative incentives
and remove obstacles to performance-based purchasing, consolidation
and mergers.
- Harness
the power of CSAT by identifying elements from its National
Workforce Plan that converge with COMAT priorities.
- Identify
and work with additional partners such as the NGA Center for
Best Practices, the National Quality Forum, SAMHSA, NIDA and other groups
that can address provider needs for new technology, minimal standards
of care, standardized assessment, etc.
- Position
COMAT as an agent for communicating to states, legislatures and purchasers
the critical need to implement performance measurement strategies.
Building upon these first
organizing steps, COMAT Co-directors A. Thomas McLellan and John Kimberly
will develop a written summary of conference proceedings, including a set
of proposals for systematic identification of change agents with whom researchers
and industry leaders can work to develop replicable models for re-organizing
treatment systems, instituting best practices in reimbursement and contracting,
and fostering introduction and evaluation of best clinical practices. |
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