Shatterproof started by convening a committee of stakeholders with the financial and industry clout to design and enforce care standards. This group included six large national health plans — Aetna, Anthem and subsidiary Magellan Health, Beacon Health Options (part of Centene), Cigna, and UnitedHealth Group — and academic researcher Dr. Thomas McLellan, who founded the Treatment Research Institute and served as Senior Editor for the U.S. Surgeon General’s 2016 report on substance use.

Shatterproof chose these collaborators strategically. They invited the large national health plans because as leaders in the industry, once they selected and implemented quality standards for substance use care, other health plans would likely do the same to stay competitive in the market. The plans wanted to join the committee in order to have a voice in defining national care standards. They also committed to funding one third of the project’s piloting and implementation fees. Lastly, it was important to have Dr. McLellan at the table because he had the subject matter expertise to ensure the standards aligned with the medical research and the reputation to legitimize the standards beyond the committee.

Over the course of eight weeks, the group leaned on their shared expertise and the academic evidence to establish eight standards, or principles of care, for quality substance use disorder treatment.

Shatterproof’s National Principles of Care

Once Shatterproof was able to build consensus on the principles of quality substance use care, the committee's next step was to identify and test associated metrics for each one. The committee started by reviewing existing Medicaid measures to minimize the administrative burden of data collection and mitigate resistance provider organizations might express toward entirely new metrics.

When selecting metrics, the committee aimed to prioritize measures with high impact on patient experiences and care outcomes. At the same time, the metrics had to be feasible to collect from providers, patients, and insurance claims. They also wanted to avoid measures that would inadvertently and inequitably penalize clinicians who work in lower-resource settings or appropriately readmit patients into acute care settings.

To strike that balance, the committee solicited feedback and validation from third party experts across the industry. The group solicited input on the metrics through a National Quality Forum expert panel made up of substance use treatment experts, medical providers across the full spectrum of acute and non-acute care, payers, patient advocates, and data scientists. Through multiple rounds of review, these experts evaluated, refined, and ultimately validated the list.

The final list of metrics (located in the appendix) can be sourced from three data sources: payer claims, treatment facility surveys, and patient experience surveys. The survey questions derive from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program and Experience of Care and Health Outcomes (ECHO) surveys.

The next step to truly drive change in the market was to go beyond defining and measuring quality care, and to start incentivizing it. To do that, Shatterproof created the Addiction Treatment Locator, Assessment, and Standards Platform, or ATLAS. ATLAS incentivizes system-wide care improvement by publicly providing the quality data of specialty substance use treatment facilities for patient, clinician, and plan use. This transparency serves a distinct purpose for each stakeholder group. It:

• Empowers patients to make informed care decisions. With ATLAS, patients can select high-quality clinicians and identify facilities with evidence-based practices and services. They can also see which facilities are in-network for their insurance type.
• Guides provider organizations to develop targeted quality improvement efforts. By reviewing their own data and seeing how they compare to an aggregated peer benchmark, provider organizations can identify specific gaps or areas for improvement in their current performance. This is especially valuable for provider organizations looking to enter value-based arrangements.
• Enables health plans to create high-quality, performance-driven networks. When building provider networks, health plans can selectively include/exclude and give preferred/non-preferred status to facilities based on their level of adherence to quality standards, leading to lower total cost of care. This gives plans using ATLAS a competitive edge over those who do not take an evidence-based approach to cultivating their provider networks.