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.
- Value is often experienced by people who are NOT the patient
- Almost all treatment programs are primarily funded by the public sector, and funding patterns are not sensitive to performance but to political imperatives
- Excessive regulation and bureaucracy impede quality improvement efforts.
- Not enough is known about value realized through investment of dollars.
- 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.
