ASAM Criteria Software

Report
THE ASAM CRITERIA SOFTWARE
TM
American Society of Addiction Medicine
44th Annual Medical-Scientific Conference:
April 26, 2013, Chicago, Illinois
ASAM Disclosure of
Relevant Financial Relationships
Content of Activity:
ASAM Medical –Scientific Conference 2013
Name
David Gastfriend
Commercial
Interests
Relevant
Financial
Relationships:
What Was
Received
Relevant
Financial
Relationships:
For What Role
Alkermes, Inc
Recovery
Search, Inc
Salary, Stock,
Options
Royalties
Company Officer
Rodney Conrad
FEi Systems, Inc
Salary
Company Officer
Paul Earley
Earley
Consulting Fees
Consultancy LLC
Alkermes, Inc
Honoraria
Company Officer
Software
Consultant
Speaker
No Relevant
Financial
Relationships
with Any
Commercial
Interests

AGENDA
Rationale & background for a new standard
of assessment & treatment planning
 Dr Gastfriend - 15 min

Hands-on experience at the computer
 Mr Conrad & Dr Earley - 45 min

Interactive discussion
 Drs Gastfriend & Earley & Mr Conrad - 25 min


ASAM’s plans: Dr Gastfriend - 10 min
Participants’ reaction: All - 25 min

Rationale & background for a new standard
of assessment and treatment planning
 ASAM’s Goals
 HBS’s Report Recommendations
 SAMHSA’s Open Behavioral Health Information
Technology Architecture Project
Client
Researcher
Employer/
Payer
Managed
Care
Counselor
Supervisor
Society
System
Accreditation Body,
Government
Corbel (Body)
• National Treatment Center Study - 450 programs (U. of GA)
• >70% of respondents using ASAM Criteria by 1996
• For-profits: 54% less likely to adopt (p=.02)
• Single-level programs: 34% - 42% less likely than multi-levels (p<.01)
• Dual diagnosis capable programs:
3.4 times more likely to adopt (p ≤.01)
• Programs closing within 24 mos.
were less likely to be ASAM adopters in 1996 (p<.05)
• Programs closing within 6 mos. – even lower baseline adoption
HARVARD | BUSINESS | SCHOOL

Providers
 Jerome Rhodes, President, Recovery Division, CRC Health Group
 Nancy Paull MS, CEO, SSTAR of MA and RI
 Ron Jackson MSW, Director, Evergreen Treatment Services, Seattle WA
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Payers
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Government/Non-Profit
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Hyong Un MD, Chief Psychiatric Officer and Head of EAP, Aetna
Gary Henschen MD, Chief Medical Officer-Behavioral Health, Magellan
David Pating MD, Chief, Addiction Medicine, Kaiser Permanente SF Med Ctr
Tom Trabin PhD, Assoc Dir, Adult Care, Alameda County Behavioral Health, CA
Mady Chalk PhD, Dir, Center for Performance-Based Policy, TRI-U of PA
Daniel Kivlahan PhD, V.A. Assoc Nat’l MH Program Dir for Addictive Disorders
Andrew Saxon MD, Psychiatrist, VA Puget Sound
Eric Goplerud PhD, Research Professor, Geo Washington U/NORC
Carol McDaid, Principal, Capitol Decisions, Washington DC
Douglas Marlowe JD, PhD, Sr Investigator, TRI-U of PA; NADCP Science Advisor
Software Developers
 Skip McGaughey, Executive Director, Open Health Tools
 Simon Budman PhD, CEO, Inflexxion
 Ken Tubman, CEO, Claricode
HARVARD | BUSINESS | SCHOOL

Operates 145 clinics treating 30,000 people

Largest behavioral health provider in U.S.

Devotes significant resources to payer approval

Each center has 3-5 FTEs dedicated to UR

~20% of cases are contested by payers

~30% of MD time is lost interacting w/payers
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If this administrative time is reduced only slightly,
the PPC software could yield substantial savings.
Also, CRC recognizes the benefits
that increased reliance on health IT could provide.
HARVARD | BUSINESS | SCHOOL

Leading concerns:
◦ Cost 73%
◦ Time 48%
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35% indicated that MDs earning $110,000 or more are conducting
assessments; 46% indicated that the assessments take 60-90 min
Significant value if ASAM’s eCriteria can save time with payers:
31% are waiting ≥half a day for insurance authorizations
Treatment centers would find ASAM’s eCriteria a +value proposition if:
◦ It improves treatment outcomes – 80%
◦ It improves and standardizes assessments – 72%
◦ It reduces time spent negotiating with insurance companies – 66%
◦ It provides certification as “ASAM compliant” (42%) or CEU credits (39%)
HARVARD | BUSINESS | SCHOOL

For Patients

For Payers

For Providers
◦ Improves Patient Outcomes
◦
◦
◦
◦
◦
Improved Patient Outcomes > Lower Long-Term Costs
Standardizes approval process
IT can facilitate/automate approval process
Decreases expensive & unnecessary overtreatment
Improves inter-rater reliability
◦ Facilitates reimbursement process through
fewer disputes, decreased administrative burden,
and faster turnaround on payment
◦ Provides training to new counselors
◦ Generates sophisticated reports & analyses
HARVARD | BUSINESS | SCHOOL

Effective, reliable treatment planning
requires that both be used together

The ASAM Criteria Software undergoing nationwide release
by U.S. Substance Abuse and Mental Health Services
Administration (SAMHSA)

The ASAM Criteria text is synchronized
with the ASAM Criteria Software, such that
definitions & specs in the text for the dimensions,
levels of care & admission decision rules serve as the
reference manual for the ASAM Criteria Software
released by SAMHSA
ASAM’s Criteria Software – Commercial Plan
• A full, patient-based, computer-driven, counselor tool
• A comprehensive psychosocial, implements all PPC-2R decision rules
• A quantitative, reliable & valid LOC recommendation & justification
• Current Use: Norway (10 sites)
• Goals: International standard & sustainability
• Commercialization: Guided by Harvard Business School Business Plan
– Stakeholder interviews, member surveys, & fiscal models
• SAMHSA’s Open-Source project – nationwide behavioral EHR platform

Meaningful Use Compliant Clinical Decision Support Software

Can integrate Primary & Behavioral Health Services

Eventually EHR Compliant: HL7, SNOMED, LOINC, ICD-10, etc.

Integrated with HIT Grants for Primary Behavioral Health

Privately held, since 1999. 20-25% growth/yr. 2010 revenues ~$32 mm

150 employees. Contracts with Avalon, Westat, Abt & others
in projects at FDA, NIH, and in criminal justice parole & probation.

Contracted to rewrite the Block Grant process for SAMHSA.

HIPAA: Secure facility, encryption, security officer, & business associate
agreements with all clients. Expert in data repository de-identification.

Access To Recovery: Serves 15 of 30 state grantees.

Commercially manages WITS for 28 states & counties,
Supports 5,500 providers. FEi’s WITS team = 45 staff.

The ASAM Criteria book & Software
are companion text and application.
The text delineates the dimensions, levels of care
& decision rules that comprise The ASAM Criteria

The software provides approved structured interview
to guide adult assessment and calculate
the complex decision tree to yield suggested levels of care

The text provides background & instruction
for proper use of software. The software enables
comprehensive, standardized evaluation.

Hands-on experience at the computer
 Logging-on
 Understanding the user-interface
 Inputting mock data in selected dimensions
 Reviewing the output reports
Intuitive User Interface
Clean interface and presentation of data elements.
Intuitive User Interface
Data visualization elements.
Enhanced Report
Dynamically driven report with variable content
regions.
Enhanced Report
Improved readability and scanning of information.
Meaningful Documentation
Meaningful Documentation
The black box barrier is removed, exposing the
underlying algorithms.
Meaningful Documentation
Enhances understanding of the ASAM algorithm by
providing meaning and context.
Clear naming
Traceability
Human Readable
Narrative
Aids In
Understanding
Algorithm
Meaningful Documentation
Facilitates updates and tweaking to the algorithm.

Interactive discussion
 Understanding the implementation process,
including data privacy issues
 Anticipating the learning curve
 Measuring the ROI with
 INSTRTM: INSTant Authorization for Reimbursement
 Just-In-Time Supervision
 Accreditation, Certification, Contracting, Grants, etc.

ASAM’s plans
 Releasing to the field, training & endorsement/certification
 Research: optimizing patient care & recovery outcomes
– The Central Data Repository
 QI steps: ASAM’s Coordination & engaging stakeholders
– The National Coalition on Placement Criteria

Participants’ reaction
 Fears: Concerns & obstacles
 Hopes: Perceived benefits & needs
 Likelihood of testing & adopting the software

David R Gastfriend MD
[email protected]

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