ON THE COMEBACK TRAIL

Pressed by new laws and a new environment, NAATP found a new CEO and reemerged on the national scene

For years, behavioral health professionals have sought to build resilience in those they serve - the ability to learn from adversity and utilize inner strengths to continue forward.

NAATP - The National Association of Addiction Treatment Providers - has at times had more than its share of adversity. But it started with a bright promise in 1978, following a decade when Americans learned about the depth of the nation's alcohol and substance abuse problems, a topic first broached politically by former Iowa Senator Harold Hughes in 1969, then amplified by former First Lady Betty Ford in 1975.

Under the leadership of Bob Scott, M.Div., and its board of directors, NAATP became self supporting through a duespaying membership structure. In june 1980, the group's first full-time leader, Michael Q. Ford, stepped in. With him came rapid growth as NAATP attracted more than 650 member organizations in 45 states by 1988.

But the 1990s brought painful changes for the private treatment organizations served by NAATP. The rise of managed behavioral healthcare prompted a steep drop in patient census and forced the closure of a significant number of organizations. When Ford stepped down in early 1992, NAATP turned to Ronald Hunsicker, D.Min., who led a diminished membership through its toughest period and into the new healthcare battles of the 2000s.

Only months after celebrating the release of interim regulations for the long-awaited Mental Health Parity and Addiction Equity Act (MHPAEA), NAATP members were shocked on the eve of their 2010 conference to learn that Hunsicker, their longtime leader, was fired by the board after being implicated in a funds-misappropriation scandal. For more than two years, NAATP labored on, rebuilding its charter and its integrity under the interim leadership of Dennis Gilhousen, the former CEO of of Valley Hope, and Karen CarpenterPalumbo, a former New York State treatment official who moved on after just seven months in the top job.

After so much turmoil, and in the midst of fast-moving changes in the nation's healthcareagenda, NAATP members and industry observers greeted the appointment of former treatment executive and interventionist Michael Walsh MS, CAP as NAATP's fourth President and CEO in August 2012 with a mix of welcome and worry.

Some 18 months on, it appears that Walsh has found his stride. He has engaged the support of an experienced board, heard the needs of concerned member organizations, and through dozens of talks nationwide has emerged as a national voice for the cause of addiction treatment. His passionate, straightforward approach has helped NAATP cement new ties on Capitol Hill, strengthen its place in the broad national coalition supporting parity, address evolving clinical and ethical issues in treatment, and reassert the value of NAATP to a once-again growing membership.

The change in the organization is significant. "I can recall board meetings where there was a lot of talk about what was being done to us," said Jim Moore, CEO of Cumberland Heights (Nashville, Tenn.) and a longtime NAATP board member. "Now, the conversation is a lot more about what it is that we are going to do, where we can have an impact."

Straight from the heart

NAATP CEO Michael Walsh speaks from the heart, with the honesty of a person who understands treatment and recovery - intellectually and personally. "It's an exciting time to be in the field," he told Behavioral Healthcare, noting that "one need only look at the costs and impacts of addiction to see that it's costing our society a lot, in everything from jails and social services to healthcare and productivity in the workplace. It's time," he asserted, "for this country to have an honest conversation about addiction."

Over the past year, Walsh has done all he could to advance that conversation, having spoken to dozens of healthcare organizations nationwide. At the same time, NAATP is continuing its role as a hub for organizational networking, information exchange, and innovative advances in addiction treatment. In time, Walsh would like to see what he calls "the small conversation" about recognizing and treating addiction evolve into a larger conversation about the disproportionate role that it plays in the nation's larger healthcare crisis.

But in the meantime, there are other fights to win. Walsh's tenure to date has been shaped by the national fight to shape the future of addiction treatment benefits in the enabling regulations for the Affordable Care Act and the MHPAEA, by running scientific debate about what constitutes "good" addiction treatment, and by the need as he said, "to make NAATP membership stand for something" in the ways that its members market to and engage customers in treatment.

Nashville Summit: the "like minded docs"

Moore hosted what's come to be called the "Nashville Summit" in 2012, a process that brought together NAATP CEOs and a number of medical directors - to reconsider the value of abstinence-based addiction treatment, particularly as new medication-assisted treatment (MAT) alternatives caught the eye of the payer community. "There was a feeling that abstinence as an alternative wasn't getting equal time," he explained.

After considering how best to reassert the importance of residential treatment to parity rulemakers and insurance payers, Walsh said that the group decidedto create a values statement, later adopted by NAATP, and develop the NAATP Parity Survey (see included story). The values statement was significant because in it, NAATP officially acknowledged that there was a place for MAT in the continuum of care. Months later, NAATP adopted the Summit's draft values statement, reaffirming NAATP's belief in the value of abstinence-based residential treatment as an essential part of the continuum of care.

The Summit also gave rise to a new group as the participating physicians determined to reach out to their colleagues, seeking more who saw the value in residential treatment. In time, their message caught hold, attracting more and more physicians into the conversation. In time, the group became known as the "like-minded docs" (likemindeddocs.com).

Recently, the "docs" have been working to improve outcome measures, Moore said. "We want to let the public know that NAATP supports common outcomes measures and methodologies." This desire has fueled "a new willingness to cooperate and share information" between members, a basis from which the docs hope to develop a new and broadly-applicable outcome measure.

Work by the "docs" have paid scientific dividends with an important NAATP ally -the American Society ofAddiction Medicine (ASAM). "At one time, there was a feeling that our abstinence-based docs were out of step, since many new docs coming into ASAM were trained in MAT," said Moore. But patient dialogue has paid off. "Now," he added, "the docs are working more and more closely with ASAM."

Government affairs and NAATP PAC

Propelled in large part by parity and then by healthcare reform, NAATP's government relations workgroup has seen a spike in activity. "The conversation moved from parity [passage and interim regulations] to the Affordable Care Act and the effort to convince Congress of the importance of including chemical dependency treatment in the essential benefits package," Moore continued.

"Then came a long journey to develop the final ACA and Parity rules." Throughout this period - from 2010 to late 2013 - NAATP accelerated its activity by meeting directly with key decision makers on Capitol Hill, reaching out to addiction-related organizations nationally and in the states, and by allying itself to with larger advocacy groups involved with public and behavioral health. The long gestation period for the final parity rules gave NAATP and other advocates plenty of time - and reason - to fear for the future of residential treatment, as new medication-assisted treatments were introduced and insurers pressed for cheaper, non-residential treatment alternatives.

To more effectively lobby on Capitol Hill, NAATP formed an independent political action committee in 2008 and for several years, has worked with political consultant Mark Dunn to join a coalition of "like-minded organizations that collaborate around initiatives where there's general agreement," said Ed Diehl, CEO of Seabrook House and head ofNAATP PAC.

All of that cooperation has paid off for NAATP and its members, teaching new lessons about effective advocacy. "Advocacy is a powerful tool. Done well, and with persistence, it can bring about astounding changes," Diehl explained. "Perhaps the most significant for NAATP was our involvement in a broad coalition of organizations - such as the Coalition for Whole Health, Parity Implementation Coalition (PIC), Legal Action Center, and many more - that argued effectively to get residential treatment Teincluded' into essential health benefits."

At one time, those [residential] benefits were not there, Diehl said. It took a lot of work, a lot of discussion by the coalition organizations, and timely contributions of new information including some by the like-minded docs to get residential treatment back onto the list of "essential health benefits" that emerged in the final ACA regulations that were released in fall 2013.

With the national fight over ACA benefits and parity regulations now winding down, NAATP's work on state-level parity issues is just beginning, Walsh said. Despite important victories won so far, he warned, "the fight over parity in the states is just beginning. And, it is a fight."

Increased focus on ethics

NAATP leaders are keenly aware that member organizations serve vulnerable individuals and families. To ensure that providers - and the marketers of treatment - help would-be patients and their families secure the most appropriate treatment available, a board-appointed workgroup is now completing work on revised ethical standards for addiction treatment.

The need is clear, said Carl Kester, CEO at Lakeside-Milam Recovery Centers (Seattle, Wash.) and vice-chairman ofNAATP. "There continues to be tremendous growth and opportunity in the addiction treatment field and all sorts of business ventures are being pursued. Those circumstances have led some to the use of some questionable practices."

Kester hopes that the new standards, due for release in February, will create an ethical " lens" through which NAATP-member (and someday, all) providers can better regulate the process by which would-be patients are "referred" from marketing programs or other professionals. Ideally, he noted, a treatment provider's first obligation is to ensure that would-be patients are referred to the "right" treatment, regardless of who provides it. However, the pressure to put "heads in beds" can lead unethical providers to make misleading promises, lowball treatment costs, or claim outcomes that don't square with the facts.

NAATP's draft ethics standard is expected to set "high standards of honesty and openness in all interactions with customers," and will according to Walsh, be a key subject of discussion at NAATP's 2014 Conference in May.

"I find that there is tremendous passion, energy, and expertise around the table," Kester said. "Members can feel good about where NAATP is going." Longer term, the goal is clear: "We've got to be synonymous with the best of the best."

BY DENNIS GRANTHAM, EDITOR-IN-CHIEF