Rewarding results: Improving the quality of treatment for people with alcohol and drug problems.

Substance use disorders are the nation's number one health problem, and lie at the root of many public safety and workplace issues. Improving quality of treatment is as important as improving access to treatment. Leadership for improvement must come from many sources: Congress, SAMHSA, state legislatures, state and local treatment agencies, criminal justice, welfare and other public agencies, employers and managed care organizations, providers, and community leaders. We hope that our report helps leaders see ways to improve treatment quality. Our recommendations can be summed up in a single phrase: reward results. We recognize that there are many avenues for treatment quality improvement, including training, credentialing, best practice dissemination, work force development, facility licensing standards, improvement and implementation of new models for treatment of dual diagnosis patients. We believe, however, that rewarding results is essential to motivating action for improvement. We also believe that if providers receive rewards for improved results, they will creatively open new avenues for improvement--a focus on results gives greater freedom than more detailed mandates for change. Finally, we believe that rewards for result may lead to a restructured treatment system with greater stability and correspondingly greater capacity to improve. While we have placed central emphasis on the role of institutional buyers and managers of care, we believe that the voices of patients and families must be heard. People who have progressed to the stage of recovery, and their families, often have essential insight into what did and did not work for them--their personal stories are frequently compelling and persuasive. We also believe that providers of treatment for substance use disorders are profoundly committed to serving their patients, and often have great understanding of what works. Wise managers will listen very carefully and systematically to the voices of consumers, their families, and their providers. We have advocated that buyers reward results as a central strategy for improving quality. We believe that this is the best long-term strategy, not only to effect quality improvement, but also to end stigmatization and increase resources. We wish, in closing, to reemphasize our shared beliefs that adequate resources are essential, that treating persons with substance use disorders is always emotionally challenging and often profoundly frustrating and alienating, and that those on the front line deserve our unequivocal support and our profound gratitude for their service. Legislators should adequately fund public treatment and mandate parity in insurance reimbursement for treatment of substance use disorders.