A few years ago, Bob Jordan had an interesting encounter with managed care. In his capacity then as admissions director for Turning Point of Tampa – he now heads up marketing at South Florida-based Watershed Treatment Programs – Jordan found himself on the phone with a managed care gatekeeper who just didn’ get it.
“She said I couldn’t get any more days for a client who obviously needed to be with us longer,” said Jordan, adding that, when it was his turn to talk, he brusquely told the woman she needed to do some reading up on the disease of addiction and then hung up on her in a huff. Feeling immediately contrite about his behavior, Jordan went to the offïce of his boss, CEO Robin Piper, and confessed all. “She shook her head and told me that, although she understood my frustration, that wasn’t anyway to behave.” The next morning Jordan called the managed care gatekeeper back, ready to apologize and also ready for a dressing down. “I started apologizing but she cut me off, saying that she had taken my advice and had indeed done some reading up on addiction,”Jordan said. “hen she authorized another week for my client!”
Realizing that results are rarely this surprisingly positive when its treatment center members take hard-edged attitudes with managed care providers, the National Association of Addiction Treatment Providers, Naatp, has long been seeking ways it could help its membership improve relations with managed care companies, and boost revenues in the process. In May, toward this end, the association unveiled the Naatp Managed Care Toolkit at its Leadership Conference in Palm Beach, FL.
‘In 2003, our board started looking for ways we could help our members more effectively manage their relations with managed care companies,” said Rosecrance Health Network CEO Phil Eaton, who also sits on the Naatp board. Eaton worked alongside fellow board member Renee Popovits, who led the managed care toolkit effort and in her day job is a partner at Popovits and Robinson, a law fïrm that does extensive work for addiction industry clients. Given the fact that over 90 percent of commercial payers are now to some degree employing managed care techniques are part of their business, up from 10 percent 15 years ago, Naatp believes it is crucial for its membership growth to begin to work more closely with commercial insurance payors.
The response of much of the private side of the treatment industry to managed care has been to drop acceptance of commercial insurance altogether, accepting only cash pay from clients that can afford it. SAMHSA data show that the trend toward self-pay has been fairly dramatic, with self-pay by 2002 accounting for 31 percent of industry payments – which overall tend to be dominated by government grants – up from 25 percent in the mid-1990s. And anecdotal evidence strongly suggests that the self-pay trend has only accelerated since 2002. Naatp President Ron Hunsicker believes that the trend toward self-pay, with treatment centers increasingly targeting exclusively a high-end demographic, will inevitably hit a growth wall, perhaps relatively soon.