Solving The Aftercare Conundrum
1. Aftercare conundrum: In most cases, SUD treatments are successful while clients are participating in active treatment (residential or outpatient programs). However, the likelihood of relapse greatly increases in the year following discharge. That leaves us to wonder what happened (or did not happen) between discharge and the one-year mark.
Why doesn’t SUD treatment have long-term success?
The missing piece following discharge? Aftercare. Without effective follow-up, positive outcomes achieved during active treatment will rarely be sustained. What’s preventing treatment providers from prioritizing aftercare? Primarily, third-party payors' approach to SUD treatment aftercare makes aftercare financing cumbersome and because of the lack of regulatory support, providers must take on the financial and organizational burden themselves
For instance, to the best of our knowledge, there is NO billing code covering aftercare support, in other words, no possibility for SUD treatment providers to be compensated for services that – de facto – they cover. Conversely, there are billing codes for isolated services (e.g., visits to a psychologist, a psychiatrist, enrollment in standardized low intensity programs), but not for aftercare support as a whole, making access to aftercare difficult.
Furthermore, clients must determine what specific services match their needs and are covered by their insurance. The scope, extent, and claims process varies with plans and geography, and services are subject to stringent pre-authorization processes.
Because there is little regulatory support, alumni and support groups are usually responsible for SUD treatment aftercare.
2. Program alumni:
Currently, SUD treatment aftercare (to the contrary of behavioral treatment that is better organized) is left to support groups (e.g., AA support groups) and providers who finance aftercare service costs on their own. While aftercare support is usually a key part of an SUD treatment plan, since there is no billing code it is not reimbursed through insurance. This lack of coverage results in poor aftercare support, and is one of the primary reasons why long-term success is low for clients post-discharge.
3. Business structures:
Our background in business consulting has allowed us to determine that basic small to medium SUD treatment providers salaries are scaled as follows:
- Upper management: 6.5
- Mid management: 4.5
- Operations: 3.5
- Tech + outreach: 2.5
This structure is scaled to education levels and related responsibilities. However, it does not reward the technicians and the outreach team who work the closest with the clients. These staff members greet incoming clients, they complete the basic intake and discharge processes with clients, and they often build relationships with clients. Ultimately, client success is closely tied to the quality of the least compensated staff members. Aware of this situation, some providers have implemented various “incentive” programs that are (illegally) financially driven.
4. Legal protections & unintended consequences:
Because of its recent expansion in furtherance of the ACA, one of the issues that has plagued the SUD treatment industry is the practice of kickbacks. Such a despicable practice comes in multiple forms.
At the federal and state levels, legislation aiming at preventing kickbacks has been enacted and enforced. However, these anti-kickback laws make it difficult for SUD treatment providers to legally incentivize their outreach team as well. Many providers don’t even realize that it’s possible to ethically incentivize your outreach team.
This poses another issue because motivated outreach team members are key to effective aftercare, and effective aftercare programs are key to ensure clients’ progress acquired during active treatment bears long-term fruits.
As seen above, third-party payors’ focus is active treatment, leaving the burden of aftercare support to providers and volunteer organizations.
This reality calls for a new paradigm to motivate SUD treatment providers’ outreach teams.
5. Incentivizing your outreach team based on their participation in clients’ successful recovery.
This kind of incentive is not referral based, but rather based on outreach teams’ social efficiency. What does this entail? By participating in clients' treatment success, actively seeking out clients post discharge, and contributing to their long-term sobriety, members of the outreach team can earn incentives based on client success (not how many clients they bring in). The costs of implementing aftercare support will ultimately be offset by the increased client success. To be non-referral based, the incentive program MUST cover both active treatment AND aftercare (extended recovery), therefore the incentive’s focus is client’s welfare and not the amount of business generated by the outreach team.
6. How to implement an efficient aftercare program?
- Education:
o The outreach team must be trained in how to support clients after discharge
o Clients must have access to materials and tools designed to help them succeed.
- Outcome surveys:
o Outcome surveys must cover progress during active treatment
o Outcome surveys must be used to follow up with clients and track long-term success after discharge
o Outcome surveys must cover overall treatment program efficacy
- Aftercare Program financing: consult with us to review the specifics for your facility.