Addiction treatment centers are facing many challenges in today’s rapidly shifting sector. Individual drug and alcohol addiction treatment facilities need to refocus and revamp their business strategies or face extinction.
Leading online statistics and business intelligence firm, Statista, shows there was a 5.8 percent decrease in the number of addiction treatment facilities across the nation from 2016-2017. Some states like Florida significantly decreased their funding to treatment programs and facilities, resulting in 40 percent of closures for these services. In other states, treatment franchises like American Addiction Centers faced widespread closures.
Facilities can benefit from the healing power of technology. At Zealie, we work with addiction treatment facilities across the United States to help them find solutions through data analytics. As a result, we’re able to understand revenue patterns and allow substance abuse centers to maximize revenue.
If addiction treatment centers plan to stay in business, they need to know the answers to these five important questions:
1. How Much Will I Be Paid?
One of the most frustrating issues for providers is not knowing how much money they’ll receive for the care they give. This is a frequent issue for addiction treatment facilities for two distinct reasons.
First, many treatment facilities operate out-of-network with many insurance providers, meaning they don’t have contracts that identify how much a particular insurance policy will reimburse them. This is a big issue because out-of-network reimbursement rates can dramatically differ from policy to policy. For example a treatment facility might bill one insurance policy $100,000 and be paid $5,000 while another policy might pay $95,000 for the same services. That may seem like a massive variation but I see these dramatic variances from insurance policies all the time.
Second, not knowing how much they will get paid by an insurer for the services they provide is especially hard on addiction treatment facilities because of the unique patient population they serve. This patient population, although insured, is often unable to pay the difference between what the insurance company paid and what the provider billed. This is because the exact issues that they are seeking treatment for have left them with serious financial hardships as well. As a result, facilities have to heavily rely on the payments they receive from insurance companies without an accurate way to determine what those payments will be. This is one of the main reasons why many facilities go out of business.
However, Zealie holds the answer for these treatment facilities. Our solution provides users with simple to use tools that anonymously compile every treatment providers’ aggregated historical reimbursement data across Zealie’s secure platform. The easy-to-use format gives facilities a better idea of which policies adequality reimburse them for the services they provide prior to admitting a client. This gives the treatment providers the ability to take control of their financial futures like never before.
2. Should I Go In-Network?
Before treatment facilities can answer the question “Should I go in-network?” they need to answer the question: Can I go in-network? Treatment Centers need to understand it’s not always easy to go in-network. Factors like how many treatment facilities are already in-network with a particular insurance provider in a geographic region, versus how many people have that same insurance in that same region, come into play. For example, if there’s 300,000 patients insured with Anthem in a given geographic region and no in-network treatment facilities in that same region, it will likely be easier to go in-network for a treatment facility in that region because the insurance company needs an in-network treatment provider to serve all it’s subscriber’s in that area.
Assuming treatment facilities can go in-network, doesn’t always mean they should. Treatment facilities need to know what they are getting reimbursed as an out-of-network provider before they can do a cost benefit analysis. Zealie’s up-to-date claim data gives facilities a detailed view of the out-of-network reimbursement rates they are receiving. This data can allow facilities to negotiate better rates with payers because the facility can show the insurance company that they would be saving money by making the facility an in-network provider. Keep in mind, even if in-network rates are lower than those you receive as an out-of-network provider there may be other benefits to going in-network that you’re not taking into account. For example, you can take more types of policies as an in-network provider like HMOs and EPOs, you’re not just restricted to PPO policies. Also, deductibles and out-of-pocket maximums can be significantly less for in-network services than out-of-network policies which means a patient’s responsibility is significantly decreased. Finally, being in-network can generate patients from the insurance company because you’re listed as a in -network provider on the insurance companies website.
Facilities need to take all of these aspects into account when deciding whether or not to go in-network. Zealie can help you make an informed decision by providing you with the critical information that can help you weigh your options.
3. Am I Marketing Effectively?
Just as it’s hard to know what insurance will pay out-of-network providers, it can be equally hard to identify an effective marketing strategy. Many facilities have trouble tracking how much they spend on specific marketing campaigns and how effective those campaigns are. Zealie’s features can help you with marketing as well.
Our interactive heat map shows geographic locations across the United States that have more insured client populations with the appropriate insurance benefits. The heatmap visualizes this data so that facilities can better target the patient populations in their marketing efforts.
The same data tools that allow us to forecast revenue can also be used to analyze the return on investment for particular marketing campaigns. This information can be critical when planning future campaigns. If you don’t know the return on investment of all your marketing campaigns, you cannot make strategic marketing decisions which is one of the many reasons why I see facilities in this sector going out of business. Facilities need Zealie’s essential datato stop wasting money on ineffective marketing campaigns.
4. How Important are Good Clinicians and Detailed Documentation?
I cannot overemphasize the importance of good clinical documentation. If insurance companies ask for medical records and they don’t meet compliance standards, you may find yourself in a situation where you’re being audited. Often, I see failing companies come to Zealie because owners don’t realize the reason they’re not getting paid is due to poor clinical documentation. Zealie provides our clients with the means to safeguard and maintain good clinical documentation. There are three components to effective clinical documentation: good notes, good training, and good quality control and assessment.
Good Notes: Owners need to ensure that their staff regularly takes the time to fill out notes. Electronic health record (EHR) systems that require notes to be filled out in each section before they can be signed can help regulate this. Zealie’s clinical compliance staff reviews staff notes on a regular basis and notifies the facility if they don’t meet medical necessity standards.
Good training: A facility should also offer staff proper training that helps them review ensure progress notes are fully detailed and meet with compliance guidelines. Zealieprovides staff training and oversight that helps addiction treatment facilities to operate efficiently.
Good Quality Control & Assessment: Zealie regularly updates our clients on changing clinical compliance standards and reminds clients to maintain and assess the quality of their note-taking according to guidelines.
It’s important to think about clinical notes with a long-term mindset. Without good notes, you have no evidence to back up your treatment and therefore might not get reimbursement for your services. Without quality records, the whole system can fall apart.
5. How Important is Data?
As you can see from above, the most important questions are answered by data. From clinical notes, to reimbursement rates, marketing and admissions decisions, every facility should base their business strategies on data. Using big data is essential to surviving within the addiction treatment field — and that value can bring treatment facilities more opportunities for success.
Five years ago, anyone could enter the addiction treatment space and do relatively well. During that time, insurance companies were still assessing how to reimburse facilities for their services and were paying exorbitant rates. Now that insurance companies have become more sophisticated, data is more relevant than ever.
When addiction treatment facilities come to Zealie, they’re often struggling to survive. Within a few months of utilizing our software and realizing the depth of information it can provide, treatment facilities begin to thrive by making more insightful business decisions and implementing successful, long-term strategies.