C4 Recovery Solution's predecessor organization COB (the Committee on Benefits) came into being at a time of unparalleled crisis in the US addiction treatment field. The treatment industry was poised on the brink of the impending "managed cost" correction. In less than 5 years the industry’s 35,000 beds would shrink to less than 3,000. Most providers were defenseless, having little or no ability to demonstrate to funders and payers that their services were indeed making a difference. Consequently, financial resources were diverted from addiction treatment at an astounding speed.
Against this backdrop, C4 Recovery Solutions's predecessor organization COB (the Committee on Benefits) embarked on a mission to develop strategies for increasing access to quality addictions treatment by using actual clinical and financial outcome data to both manage programs and pay for services. COB identified three goals for this effort:
- to reduce inefficiencies in service delivery in order to better use dwindling financial resources,
- to convince funders and payers that it would provide a good return on investment to pay for addiction treatment and,
- to develop innovative funding structures for the reimbursement of treatment services.
C4 Recovery Solutions was motivated to identify solutions against the backdrop of the treatment system's glaring inability to demonstrate its clinical and cost effectiveness. Even today, over two decades later, the treatment system has not adequately addressed these issues. Not surprisingly, as we sit on the threshold of the next revolution in healthcare, i.e., the Affordable Care Act (ACA), many providers are no better prepared to demonstrate the value of treatment than when C4 Recovery Solutions began nearly three decades ago.
So, our mission as defined in the three goals above, is exactly now as it was then. What has changed somewhat is the vision of how we are going to accomplish C4 Recovery Solutions' original mission. The organization began with the flawed assumption that if we could demonstrate the ability to collect outcomes to prove the value of treatment, most of the field's funding problems would be over. Over two decades ago we soon came to realize a bitter truth -- that almost all of the significant stakeholders in the addiction treatment process felt threatened by the use of outcome data, for a variety of reasons:
- Policymakers were threatened because they had been making poor decisions,
- Treatment providers were threatened because they had been providing less than optimal services, and,
- Commercial insurance companies and government payers were threatened because they had been paying for the wrong services.
The bitter truth was that no one we encountered was interested in outcomes or actually changing what they were doing, because for everyone, the primary driver was payment -- the one thing that they were not willing to jeopardize. Outcome, which made everyone accountable, was something that threatened all and appealed to none.
Today, we stand on the brink of a far greater upheaval than 25 years ago, but many of the strategies to address the challenges of the ACA are similar to those of the past. C4 Recovery Solutions' three goals remain the same and we will continue to reach for them by influencing key stakeholders through conferencing, collaborating, convening, and consulting.