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Healthcare leaders call for new reimbursement model

Megan Pauly
Delaware Public Media
Healthcare leaders discuss challenges in addressing Delaware's opioid epidemic.

Christiana Care hosted its fifth annual addiction medicine symposium Tuesday. Healthcare leaders discussed factors contributing to the state’s opioid epidemic, and how to address them.

Chief of Christiana Care’s Division of Addiction Medicine Terry Horton says he’s dedicated to providing treatment on demand.


“To be able to take a patient who we identified, address their opiate withdrawal, have them agree and engaged to enter into drug treatment and then transition them seamlessly – next day – into drug treatment is kind of critical," Horton said.

New data indicates that two-thirds of Christiana Care’s substance abuse inpatient patients are agreeable to treatment, and 60% are engaged in treatment a month later.

Once someone agrees to seek treatment, Horton says Connections – the largest mental health and substance use disorder treatment provider in the state – helps connect them to care.

Horton says their record for getting someone into a drug treatment program: 12 hours after submission. And he adds they haven’t faced a shortage of drug treatment beds – yet.


Connections CEO Cathy McKay says one of the biggest challenges she's seen: holding providers and insurers accountable for covering at least 30 days of inpatient care, as mandated by law earlier this year.


“But we’re talking about people that need variable lengths of care that are based on their condition and how well they’re doing, whether they have co-occurring issues, whether they have a comfortable environment to come back to and all those other things.. and almost never will that happen [stabilization] in that amount of time," McKay said.


Delaware’s Public Health Director Dr. Karyl Rattay says the state needs to transform the way healthcare is paid for.


“Quite frankly, this current service we have – which is a fee for service model – doesn’t really help support all the needs that people have," Rattay said.


Rattay says the system needs to instead incentivize recovery, and reward providers for achieving better healthcare outcomes. McKay agrees – and says that before 2015, the system was performance-driven.


“So there were specific things you had to do. You had to provide the information every month and if you hit your performance targets you got paid a certain amount," McCay said. "If you didn’t, you got penalized a certain amount.  But one of the things you were required to do as part of that contract was to have a criminal justice liaison. But the cost of that was built into the reimbursement method.”


Under that model, McKay says the criminal justice liaison would coordinate with the individual in need, their probation officer, the drug court and others involved in that person’s care and treatment.


Under the current fee for service model, she says that coordination and cohesion is missing. McKay says work done by a single criminal justice liaison is now handled by multiple people because of the way the reimbursement system is set up.


Dr. Rattay says she’s in the process of meeting with local and national experts about the topic – and hopes to have a new reimbursement system in place for next year.





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