When Shatterproof launched its new ATLAS (Addiction Treatment Locator, Assessment, and Standards Platform) project, funded largely by insurance companies, as a pilot in six states, opioid treatment programs (OTPs) of New York State said yes, they want to participate. The reason is not because OTPs are interested in having disgruntled patients post complaints in a public site, identifying programs by name, but rather because participating is an opportunity for programs to be included with the full continuum of what is traditionally considered “mainstream” addiction treatment.
In other words, not participating would be a lost opportunity.
Allegra Schorr, President of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA), said that the goal of the ATLAS project, which includes all substance use treatment providers interested in participating, is to create an online platform that is accessible to consumers. For prospective patients, the project means they can put their insurance information and other parameters into the website and find out which projects work best for them. Schorr is on the advisory board of Shatterproof for New York State, and was invited to present on the program at the American Society for Addiction Medicine conference which was to have been held last spring in Colorado (but was held virtually due to the pandemic).
ATLAS also allows patients to “rate” their experiences with various programs, just as “Yelp” does for restaurants and other businesses. Schorr bristles at the “Yelp” analogy, however, saying “the platform doesn’t look like Yelp – it’s much more sophisticated.” And the end users of ATLAS are not only patients – on the contrary, they are state agencies, providers, and insurance companies, as well as patients, she said. “All of those pieces are in the mix,” said Ms. Schorr. “That’s why I would not leave OTPs out.”
And bottom line: only OTPs can provide methadone for opioid use disorder. “If you don’t have OTPs you’re not going to have methadone,” said Ms. Schorr. “Right off the bat that is why you must have OTPs on this list.”
The field of substance use disorder (SUD) treatment has a history of being siloed, and this is especially the case for OTPs. This kind of treatment needs to stay in the mix.
Bringing in the payer has been a key element of Shatterproof’s work, obviously. “Shatterproof has been trying to get them a seat at the table right from the beginning,” said Ms. Schorr. “And my sense is that this is successful. It’s making sure that the insurance companies are really participating.”
Shatterproof wants to make sure there’s a place that all stakeholders can go to for a directory and a database that’s easily accessible, Ms. Schorr told AT Forum. “It’s fairly aspirational,” she admitted, because what is needed is a database which has at least some objective criteria – not just patient comments. “That’s where things become complicated,” she said. “This isn’t an easy goal.”
But a very good reason for including COMPA and OTPs in the New York ATLAS Pilot is this: to get OTPs included. “This is going a step beyond just a directory,” she said, noting that the New York Office of Addiction Services and Supports (OASAS) already has a directory. “Different stakeholders each have a different voice in this process,” said Ms. Schorr.
More than “here is a directory and here are the services”
There are so many missing pieces, even in states with directories. “We need to go beyond ‘Here is a directory and here are the services,’” said Ms. Schorr. “If you just say, ‘Here is a listing of substance use disorder treatment centers, with inpatient and outpatient,’ and leave it at that, you don’t really know what is being offered – what are these services and what do they mean?”
Even within New York there are different licenses for SUD treatment – not only for residential and detoxification, but even different kinds of outpatient treatment. There are OTPs, there is methadone and buprenorphine and naloxone, and there is office-based opioid treatment – all within the realm of outpatient treatment for one specific kind of SUD.
“It’s often difficult to understand from a director, and even from providers’ websites, if the provider is offering MAT directly or referring to an off-site prescriber,” said Ms. Schorr. “And if they are prescribing on-site, which medications are they prescribing?”
“I give Shatterproof a lot of credit for gathering all this information and making it understandable,” said Ms. Schorr.
That doesn’t mean there isn’t controversy, especially among OTPs. “Many aren’t comfortable with the project, or at least not convinced,” she said. “But I believe, and my colleagues in New York believe, that it’s very important for OTPs to be involved and included in the ATLAS project.”
Rob Kent, former general counsel for OASAS, met with Gary Mendell of Shatterproof many times as the state considered and finally bought into the pilot. Before he left OASAS, he pushed for involvement with the ATLAS pilot because “I felt Gary Mendell had enough motivation to make this happen,” said Mr. Kent.
And, in complete agreement with Ms. Schorr, although with more colorful language, Mr. Kent said “I would rather be in the tent pissing out than outside the tent getting pissed on.”
The original plan of Shatterproof was to set up an actual rating system. With ATLAS, Shatterproof is aiming mainly for some quality indicators. But Shatterproof will not use a scoring system to rate programs. At least, not yet.
“During a time when social isolation, economic hardship and disruption of everyday routines are worsening our nation’s addiction crisis, ATLAS is a critical new resource,” said Shatterproof CEO and founder Gary Mendell in a statement accompanying the July 21 announcement of the project. “When my son Brian needed addiction treatment, my family agonized trying to find him the right care. It was impossible to know who to trust.” Brian died from an overdose in 2011.
Included on the quality measures for each program:
- use of best practices based on Shatterproof National Principles of Care (https://www.shatterproof.org/shatterproof-national-principles-care);
- feedback from other patients once a minimum threshold of 20 responses for the facility is met, updated every 24 hours;
- an Addiction Treatment Needs Assessment (https://www.shatterproof.org/need-help/addiction-treatment-needs-assessment).
ATLAS was funded by Arnold Ventures, the Robert Wood Johnson Foundation, and a coalition of national health care companies: Aetna, a CVS Health Company; Anthem Inc.; Beacon Health Options; Blue Cross Blue Shield of North Carolina; Cigna; Magellan Health; and UnitedHealth Group.