October 7, 2013

Having insurance coverage for treatment for substance use disorders (SUDs) is critical for patients, but it only works if treatment providers accept insurance. CRC Health Group is unusual in listing the insurance companies it contracts with on its website, and officials of the Cupertino, California–based national treatment chain talked to ADAW last month about the role of the Affordable Care Act (ACA) in increasing census rates thanks to improved insurance coverage.

Andy Eckert, CEO of CRC, said the chain’s 140 programs, including the more than 40 that are residential, are geared toward commercially insured patients with a focus on the young adult population. This is the group that under the ACA can be insured under their parents’ plans. “That’s giving a tremendous uplift” to the ability to provide treatment to this age group, said Eckert.

“We’re investing heavily in this,” said Eckert. “This year alone we’re adding more than 200 beds, particularly in our programs that are geared toward commercial insurance.” When the ACA is fully implemented in January, an even larger segment of the population will be covered, he said.

Insurance battles

But insurance companies do not always want to pay what treatment costs. “To some extent, the insurance business is always in tension with the medical requirement to provide treatment the right way,” said Barry McCaffrey, CRC board member, and a retired U.S. general and former director of the Office of National Drug Control Policy. He noted that at Life Healing Center, CRC headquarters for National Recovery Month, the staff-patient ratio is one-to-one. This is important “if you’re going to provide clinically, scientifically based, outcome-based therapy, and deal with people who have serious trauma issues, compounded by drug and alcohol abuse, and if you’re going to ensure their safety,” McCaffrey told ADAW. “We also want a workplace where our professionals get an adequate salary and have healthcare themselves.”

CRC has been very active in Washington about what levels of care will be included under the Mental Health Parity and Addiction Equity Act — the parity law, said Eckert. There is still no final rule. “We’re advocating that residential treatment be included in the benefits package,” he said. “At the same time, we are aggressively trying to respond to today’s marketplace.” “Let me add a caution,” said McCaffrey. “One program that is universally powerful is art therapy, and that doesn’t sound like a medical procedure.” And it’s an example of the kind of program that is not likely to be funded by insurance. “We know we can get people into sobriety, detox them safely and do relapse prevention — but a lot of it is an art,” he said. “The ACA needs to take that into account.”

Partial hospitalization

Many programs are paid by insurance at the partial hospitalization but are actually residential. CRC is working with an insurance company on an innovative program for opioid addiction in rural California, setting up partial hospitalization programs where the provider is already active. The program runs five hours a day, five days a week, and is designed and customized for this payer. “We’re hoping this will be a creative way that we are addressing a need,” said Eckert. “The reality is that we have to continue to find out how to meet folks where they are.” In other words, the treatment has to be affordable.

Also attending the September 20 news conference in Santa Fe: Robert Garcia, sheriff of Santa Fe County; Alexis Duprey, reigning Miss New Mexico 2013; Barak Wolff, former director of the New Mexico Public Health Division and current policy analyst, New Mexico Senate Public Affairs Committee; Andrew Black, field representative to U.S. Senator Martin Heinrich (a Democrat); Jennifer Manzaneres, field representative and tribal-substance abuse liaison to U.S. Congressman Ben Ray Luján (a Democrat); and recovery advocate Steve Brugge, himself in long-term recovery.

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