At a time when Americans are dying by the thousands from opioid and other addictions, substance abuse treatment programs can save lives. Picking a good program isn’t easy, though.
While quality ratings are ubiquitous in healthcare—say, for nursing homes—they have been remarkably absent in substance abuse treatment. The Houston-based Arnold Ventures (previously the Laura and John Arnold Foundation) is looking to change that with a recent $1.3 million grant to Shatterproof, a national nonprofit organization dedicated to ending addiction, to launch an addiction treatment rating system. “If you Google ‘opioid addiction treatment centers,’ you’ll get tens of thousands of results but virtually zero credible information about the quality of care these facilities provide," said Arnold director of public health Erica Brown in a press release late last year. "Patients desperately need more information to better manage their health." This is the gap that the funding will address.
Arnold’s interest in this topic dates back at least to 2016, when it issued an RFP in a quest for ideas for “evaluating addiction treatment programs and strategies for people with opioid use disorder” as part of its Pay for Success work. The issue is a natural fit for a foundation that works to promote evidence-based policies and practices across a range of funding areas. Quietly, it’s become one of the few national funders in a niche that’s been largely neglected by philanthropy, even as the toll of the opioid epidemic has grown steadily more devastating.
Last fall, Arnold made an $800,000 grant to researchers from Brown University and Rhode Island Hospital to conduct the first randomized, controlled trial of a peer-based recovery intervention for patients at high risk of overdose. The foundation is also funding a two-year study by researchers at Boston University who are digging into unethical and fraudulent practices by treatment centers that exploit opioid addicts and bilk insurance companies. And it gave Georgetown University over $600,000 to conduct a comprehensive assessment of state laws and policies that act as barriers to evidence-based substance use disorder treatment.
The grant to Shatterproof will support its use of “healthcare rating best practices to evaluate treatment programs in a select number of states against a standard for evidence-based addiction care developed under the guidance of the National Quality Forum (NQF), a nonprofit that measures healthcare performance.”
This builds on Shatterproof’s work last year, when it released the National Principles of Care for substance use disorder treatment. Now, the organization will measure whether addiction treatment programs are delivering care that aligns with these evidence-based best practices.
To accomplish this, Shatterproof will work with RTI International, a nonprofit research institute that maintains quality rating systems for the Centers for Medicare and Medicaid Services and other organizations. Before expanding nationally, Shatterproof will pilot this rating system in a select number of states through a public-private partnership with state leadership and commercial insurance carriers.
After publishing the standards, Shatterproof will “work with providers to improve the quality of their treatment programs and with policymakers to promote evidence-based treatment.” Ultimately, the Shatterproof Rating System will “standardize expectations around the quality of addiction treatment across all levels of care, settings and types of treatment.” The goal is to repair the current “fragmentation” of the system, and integrate addiction treatment appropriately into mainstream healthcare.
Shatterproof believes opioid use disorder should be treated “as a public health issue, not a criminal justice problem.” The numbers back this up. More than 49,000 people died of opioid overdoses in 2017, making it one of the deadliest public health crises in the U.S. For the millions addicted and afflicted, there are issues of both access and quality when it comes to treatment. Among the barriers widely noted are a lack of high-quality treatment facilities, gaps in insurance coverage, and the public policies and opinions that criminalize addiction.
“We know that addiction can be treated with the same effectiveness as other chronic diseases, but that this care is largely unavailable to those in need,” said Gary Mendell, founder and CEO of Shatterproof in a news release announcing the rating system initiative. “It is time that a standard be set across all of addiction treatment, and that the entire system aligns behind high-quality care.”
Research shows that a combination of medication and behavioral support is the most effective treatment for addiction. There are also promising efforts to recognize the chronic nature of addiction and treat it with the same care management practices of other chronic diseases.
But treatment only works when you can get it. Only one in 10 Americans with a substance use disorder receives treatment. Even worse, most who do get treatment do not receive care shown by medical research to be effective.
And even if treatment programs are available, it’s unclear how effective they are. “People who need help for addiction don’t know what to look for or where to turn. Right now, there is more transparent and credible information about the quality of your next refrigerator than an addiction treatment program,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in a press release. “We are taking rating system best practices from healthcare and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care, but also drive a long overdue transformation of the addiction treatment industry.”
As Inside Philanthropy has reported, national funders have been largely missing in action when it comes to the opioid epidemic. (A notable exception is the $50 million pledged by Bloomberg Philanthropies last year.) Nationally, the Cardinal Health Foundation has focused on prescription use and misuse through Generation Rx program, and the Conrad N. Hilton Foundation has also invested substantially, although it’s now winding down its substance abuse work.
Instead, the majority of funding for this issue has been at the local level by from grantmakers such as the GE Foundation in Boston and the Colorado Health Foundation. The Independence Blue Cross Foundation in Southeastern Pennsylvania and the Aetna Foundation have also contributed millions to combating the opioid crisis in local communities. As we’ve reported, Independence Blue Cross is especially involved in treatment; its STOP initiative aims to expand access to evidence-based treatment programs.
The Robert Wood Johnson Foundation was once quite focused on substance abuse issues, investing over $700 million to recovery efforts. But it phased out that work a few years back. So it’s surprising but welcome news that RWJF, along with a coalition of five national healthcare companies—Anthem, Beacon Health Options, Cigna, Magellan Health and UnitedHealth Group—has decided to join with Arnold Ventures to fund Shatterproof’s $5 million pilot project.