Less than a year into her tenure as the nation’s behavioral health head, Miriam Delphin-Rittmon acknowledges that she and the Substance Abuse and Mental Health Services Administration (SAMHSA) have their work cut out for them.
Delphin-Rittmon spoke on some of those issues during a session October 7 at the 2021 Annual Meeting of the National Association for Behavioral Healthcare (NABH) in Washington, D.C.
One of the subjects brought up during the session was the move across the behavioral health spectrum towards value-based care. Among payers, the move has been driven by many in the private sector. However, federal agencies have supported the model going as far back as 2010, as it was a core component of the Affordable Care Act that passed in Congress.
Delphin-Rittmon, for her part, believes there is promise in value-based care, but stated that it is a work in progress.
“The outcome discussion is a critical discussion,” Delphin-Rittmon said during the presentation. “We have to think about what are the impacts … of the various programs that are going to use that.”
Delphin-Rittmon also talked about outcomes measurement — which is a cornerstone of value-based care — when it comes to SAMHSA making grants to organizations. She stressed that outcomes are important to SAMHSA, but noted that such measurements can sometimes be hard to define when analyzing data, pointing out substance use disorder (SUD) treatment as an example.
Delphin-Rittmon’s argument mirrors those of others within the behavioral health industry who acknowledge the challenge of defining accepted standards of treatment outcomes.
“The outcome data is critical in terms of being able to have a sense of how a program or a brand is … working,” she said. “One thing that we … know is that it’s sometimes hard to define outcomes for behavioral health. Sometimes what we hear is, ‘If an individual relapses, is that necessarily a negative outcome?’”
Delphin-Rittmon pointed out that in the case of such a relapse, some may not view it as a negative outcome if it is a part of their eventual, long-term recovery. She acknowledged that there is room for improvement in this regard, while also sounding optimistic that a solution can be found with better data assessments.
“For us, it’s a delicate balance because … some of what we’re hearing is that the data collection is onerous,” she said. “Part of our looking at the data … to update the approaches is coming up with data elements that will be meaningful, but … that will also be culturally responsive.”
Delphin-Rittmon also talked about SAMHSA’s recent efforts at harm reduction in SUD treatment, particularly in allowing grantees to use federal funds to buy fentanyl strips. Additionally, she discussed SAMHSA helping licensed opioid treatment programs (OTPs) get medication-assisted treatments (MATs) like methadone to patients.
Delphin-Rittmon said that such harm reduction efforts can play a crucial role in helping those needing treatment get access.
“It’s an opportunity .. to plant seeds and … give people information about services and supports,” she said. “We know that individuals are struggling with substances, and what we hear is that sometimes … a window appears and that window is … tight. So we want to have information about how to access services.”