TM
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 Commercial
Interests
Relevant
Financial
Relationships:
What Was
Received
Relevant
Financial
Relationships:
For What Role
No Relevant
Financial
Relationships with Any
Commercial
Interests
David Gastfriend Alkermes, Inc
Recovery
Search, Inc
Salary, Stock,
Options
Royalties
Rodney Conrad FEi Systems, Inc Salary
Company Officer
Company Officer
Company Officer
Paul Earley Earley
Consultancy LLC
Alkermes, Inc
Consulting Fees
Honoraria
Software
Consultant
Speaker

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 Dr Gastfriend - 15 min
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 Mr Conrad & Dr Earley - 45 min
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 Drs Gastfriend & Earley & Mr Conrad - 25 min
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Dr Gastfriend - 10 min
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All - 25 min

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 ASAM’s Goals
 HBS’s Report Recommendations
 SAMHSA’s Open Behavioral Health Information
Technology Architecture Project

Client
Researcher Counselor
Employer/
Payer
Society
Supervisor
Managed
Care
System
Accreditation Body,
Government

• 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

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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
Payers
 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
Government/Non-Profit
 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

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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
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

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Leading concerns:
◦ Cost 73%
◦ Time 48%
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

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◦ 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

• 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.
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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.

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 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
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.

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 Understanding the implementation process, including data privacy issues
 Anticipating the learning curve
 Measuring the ROI with
 INST  R TM : INSTant Authorization for Reimbursement
 Just-In-Time Supervision
 Accreditation, Certification, Contracting, Grants, etc.

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 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

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 Fears: Concerns & obstacles
 Hopes: Perceived benefits & needs
 Likelihood of testing & adopting the software

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