NCAD Spotlight: Data Will Drive Better Outcomes, Reimbursement

Joanna Conti, BS, MS, considers her family “extremely fortunate” to have found programs that treated her daughter for an alcohol addiction despite having little data to go on when choosing a provider. In her work now as the CEO of Vista Research Group, a firm she founded in 2015, she hopes to map out a future in which data can be used to better inform clinical care, create better treatment outcomes, and give families and payers tangible evidence to compare programs.

Conti will present on the use of measurement-based care and outcomes research at NCAD East, which convenes Aug. 15-18 in Baltimore. Ahead of the meeting, she spoke with Behavioral Healthcare Executive about how her family’s experiences drove her to launch companies dedicated to improving addiction treatment, the effectiveness of measurement-based care, and the independent outcomes research could be critical for the future of value-based reimbursement.

Editor’s note: This interview has been edited for length and clarity.

How did your background and personal experiences lead you to the work you are doing now and what you’ll be discussing at NCAD East?

What led me to becoming interested in the field of addiction treatment was that I had a daughter who became a hardcore alcoholic at a very early age. She was in and out of treatment for half a dozen years. I kept being put in a position where she was in the ER with extremely high blood-alcohol levels, and it was clear we would need to find treatment for her immediately. Each time, I would be forced to rely on a chance comment someone had made—"hey, you should try out this treatment center or that treatment center.” I would call them and ask them their success rate, and they would say, “Trust me, we’re one of the best.” We were extremely fortunate in that we did luck into really good treatment. As a result, my daughter has celebrated six years of sobriety as of a couple months ago and has completely turned her life around. But when the worst was behind me, I looked back and said there has to be a better way for families coming behind us to find treatment centers that are doing an effective job. As a labor of love, I decided to create a website called Conquer Addiction where families looking for treatment could search for treatment centers among all the typical factors—maybe it needs to be in a certain region or serve adolescents or take a specific insurance.

What was different about Conquer Addiction was two things: One, we didn’t even collect leads, let alone sell them. That’s not what this was about. But the most important thing that made Conquer Addiction different was that the treatment centers which had the best post-treatment outcomes would show up at the top of the family’s search. It allowed families to choose treatment centers with good success rates to send their loved ones to.

The problem was I could find all of five treatment centers in the entire country who were tracking and would report to me their outcomes. What I did next was go to an addiction treatment conference and said why aren’t you tracking your outcomes? Enough treatment center owners said, “We want to. It’s in next year’s strategic plan. But we don’t have a clue of how to do it.” I thought there was a business opportunity there.

I have a diverse background, and one of the things I have done is teach myself to program and I spent five years running a software company. I could look at this and say this is something we can figure out—how to cost-effectively provide independent outcomes research to addiction treatment facilities. I started Vista Research Group as a side project. I was running a marketing agency at the time. Shortly after, I dove into all of the academic research behind addiction treatment, and what I discovered was all of the data that showed if you monitor patients while they are in treatment and report the results to their therapists in an easy-to-understand graphical form, patients get better faster during treatment. I thought this was an obvious addition to what we can offer our treatment center clients. We have been providing progress monitoring and post-treatment outcomes research to a growing base of clients since March 2016. We now have over three years of outcomes research data. We have monitored tens of thousands of patients during treatment and thousands of patients after treatment. We now have some really great data that we can share with the addiction treatment industry. What is exciting about where we are as an industry is that we are just in the midst of a dramatic move to using patient-reported data to improve addiction treatment effectiveness.

Can you share an example of how clinicians have been able to provide better treatment through measurement-based care?

One large company has told us that INSIGHT Addiction flags underlying co-occurring disorders that were not identified in their pre-admission screening for 30-40% of their patients. Another treatment center reports that their clinicians have been able to save the lives of three patients in the past 21 months by intervening when they received alerts that the patients were seriously contemplating suicide.

What is one piece of advice you would have for how providers can develop a strategic action plan to improve their program’s results?

What we’ve learned is that it’s important to benchmark your results against those of similar treatment centers. We do an annual report where we aggregate all of the data for our clients, and it ends up being 30 different graphs, comparing what percentage of your patients have moderate to severe levels of PTSD symptoms at intake and how those improved prior to discharge, for example. All of the clients will look good with these aggregates, but when you compare your results to those of similar programs, you often will find that you are particularly good in one area and that there might be an opportunity for improvement in another. By comparing your results to norms in the industry, you can identify things that would be most useful for improving.

What I think is the most exciting part is the impact that outcomes research is going to have on the industry over the next couple years. As insurers implement value-based reimbursement, having independent outcomes research is going to become the norm. Payers are very interested in using third-party outcomes results to build the strongest network of cost-effective providers. Treatment centers who know their outcomes are better than average are investing in outcomes research so they can go to payers and use hard data to argue for higher reimbursement rates and pay-for-performance bonuses. For the industry as a whole, in two years, I’m confident we will be able to predict what type of treatment modality is likely to be most effective for a patient on the basis of their drug use history and patient demographics. That’s going to be a total game-changer for the industry. It is bringing addiction treatment to where the rest of healthcare has been for the past 20-30 years in terms of being able to use hard data to identify the most effective treatment centers and the most effective treatment modalities.