In 1988, America had a tremendous amount of addiction treatment resources available, access was achievable and much of the country was receiving help, but the industry was poised on the brink of the "managed cost" correction. In less than 5 years, 35,000 treatment beds shrunk to less than 3,000. Many treatment providers were defenseless, having little or no ability to demonstrate to the funders and payers that the services being delivered, and that payers were purchasing, were indeed making a difference in communities across the country.
In response to this veritable earthquake in addiction treatment funding, the National Council on Alcohol and Drug Dependence (NCADD) created C4 Recovery Foundation's predecessor organization, the Committee on Benefits (COB). COB was tasked with finding ways to address the challenges created by the managed cost revolution.
In 2000, COB spun off from NCADD and became a 501(c)(3), The Coalition of Outcomes Based Benefits (COBB). The new organization's goals expanded, primarily the organization sought to improve access and accountability for the treatment of substance use disorders. COBB sought to advance these goals by initiating constructive dialogue among all interested groups; educating and motivating policymakers to embrace new strategies and aiding in the design and implementation of programs. COBB worked diligently to implement outcomes-based treatment models and educate the providers across the country. In 2001, as its range of services expanded to meet the needs of a broader group of constituents, COBB evolved into C4 Recovery Foundation maintaining its public charity structure.
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:
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:
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.
For close to twenty-five years, C4 Recovery Solutions has been the thought leader in promoting accountability-based payment for addiction treatment, both nationally and internationally. As part of this effort, C4 Recovery Solutions collaborates and consults with addiction treatment providers to equip them to incorporate outcome-management systems into their operations. C4 uses four strategies to accomplish its goals: conferencing, collaborating, convening, and consulting. C4 Recovery Solutions seeks to work with interested organizations and individuals to create projects demonstrating the principles and efficacy of using accountability-based management and payment.
In C4 Recovery Solutions' formative years, it convened prestigious thought leaders (representatives of providers, payers, managed care, researchers, policy makers, the recovery community, government, and other stakeholders) to develop strategies for improving the accessibility, effectiveness, and efficiency of addiction treatment. These meetings led to the development of basic principles for improving the quality of, and access to addiction treatment through accountability-based management and payment. Out of these early deliberations grew various projects that have demonstrate that outcome data can have a profound effect on treatment delivery, access, and payment.
In the subsequent decades, C4 Recovery Solutions grew steadily and, in keeping with its goal to provide effective conferencing and convening, acquired the internationally renowned Cape Cod Symposium on Addictive Disorders (CCSAD), followed by C4 Recovery Solutions' launch of the very successful West Coast Symposium on Addictive Disorders (WCSAD). These two symposia are often accompanied by meetings that further C4 Recovery Solutions' mission, some sponsored by C4 and some sponsored by other organization. An example of the former is a convening of indigenous healers and an example of the latter is a summit focusing on fostering trauma-informed addiction services for men. Through these conferences and meetings C4 Recovery Solutions has become a leader in cutting- edge addiction treatment information dissemination and exchange.
As C4 Recovery Solutions has passed its first quarter century, it has embarked on a range of new initiatives to bring further value to addiction treatment and the recovery community. For example, we are adding a number of smaller hosted training events and symposia to enhance the capabilities of new audiences. Further, we are on the cusp of an international partnership to provide a mentoring program for addiction treatment professionals in other countries in order to enhance their skills and abilities, especially related to outcome-based treatment systems. Additionally, we are offering an exciting consulting program to assist local programs and organizations to meet their organizational challenges, especially as the US health care system undergoes for major changes. Finally, C4 Recovery Solutions will remain a strong advocate for recovery-based treatment that uses a broad ranging continuum of care, effective wrap around services, and carefully augmented by the targeted use of pharmacologic agents.
C4 Recovery Solutions looks forward to its third decade of leadership in convening, conferencing, collaborating and consulting to ensure that persons with addictions and their families receive quality and appropriate treatment services when they need them.
C4 Recovery Solutions has sponsored many cutting-edge conceptual and practical projects that reflect its interest in accountability-based addiction treatment systems. Several seminal references and documents are included here.
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