SAE was pleased to have the chance to sit down with our consultant, John Darin, for our Consultant Highlight of November. Mr. Darin has over 30 years of diversified programmatic and administrative experience in the field of social services. Since 1997, he has served as the President and CEO of NADAP, and under his leadership, NADAP has grown from 16 staff serving 1,000 clients to 250 staff serving over 30,000 clients annually. During his tenure, NADAP's Managed Care Treatment Program (MATS) produced 62% in Medicaid savings and greatly improved the outcomes for numerous chronically ill substance abusers served by the organization, and the organization's Health Home Care Management Program was designed to continue this good work. Mr. Darin currently serves as a consultant to the U.S. Department of Justice and to the U.S. Department of Education and as the Vice-Chairman of The Coalition for Community Services. He is also the Co-Chairman of the Job Creation Sub-Committee of the New York State Office of Alcoholism and Substance Abuse Services' (OASAS) Talent Management, a CASAC (Credentialed Alcoholism and Substance Abuse Counselor) and an internationally certified ICADC. Further, he is a registered NYS lobbyist and a class A board member of iHealth and CBC (Coordinated Behavioral Care), and the first Vice President of the Coalition of Community Services.
SAE’s Project Manager, Kristan McIntosh, sat down with Mr. Darin last week to learn more about his myriad of experiences working with individuals diagnosed with substance use disorders (SUD) and his expertise with care coordination services.
K: Hi John. Thanks for sitting down with me today. I’d love to hear more about what led you to work in the social service field in the first place.
J: After I graduated college with a business management degree, my first job was to serve as the Fiscal Officer for a small nonprofit substance abuse treatment agency in New York City that was then known as Exodus House. Following that job, I was hired by A Way Out, Inc., another agency specializing in working with those living with SUD, and this is where I truly found my passion. I stayed with A Way Out for 14 years, eventually becoming the Executive Vice President, and built my career on administration within nonprofit social service agencies, but I also found inspiration in the individuals who were being served and their resilience in the face of so many challenges. Therefore, I made it a point to get my CASAC and learn the clinical/counseling side of substance use treatment as well. This dual perspective has served me well throughout my career, and I think it keeps me connected to the true meaning of the work that we do.
K: Currently, you are the President & CEO at NADAP. How did that come about?
J: When I was hired as the President of NADAP, the agency was in operational crisis. The Board of Directors was deciding whether or not to close the agency down because it was carrying a debt of over $600,000; however, they were willing to give me a couple months to turn things around. Because of my good reputation and strong relationships with the Office of Alcoholism and Substance Abuse Services (OASAS) that I had developed during my time at A Way Out, Inc., OASAS actually approached me with an opportunity for NADAP a couple months after I took on the job. New York State was going through welfare reform at the time, and new mandates related to this required everyone who applied for assistance throughout the state be assessed for substance use disorders and then be referred to treatment as indicated. Because NADAP was a neutral entity (i.e., we were not providing substance abuse treatment services) and OASAS trusted me to operate the initiative efficiently, they asked that our organization conduct the assessments until the city could take over the project. The project was framed as “a deal” that would only be ours to operate for a couple months, but due to administrative restrictions on the city’s part and our good work assessing and referring, we eventually negotiated a one-year contract. Today we are about to enter into year two of a six year, $7 million contract for these services.
K: Wow! What a story! What strategies did you use to make that “deal” such a success on behalf of NADAP (and the people you serve)?
J: Well, I think the first key is always seeking to develop strong relationships and having a good reputation of doing good work within the field. That opportunity would likely not have been presented to us otherwise. But another thing I made sure to do was develop a database to track our outcomes. That way, after one year, I was able to say to the State here is what NADAP is doing for the people we serve using real data. And it was convincing enough for them to allow us to continue our operations. We also implemented regular progress reports and Continuous Quality Improvement (CQI) activities to make sure that the programs we operate are actually assisting the people we claim to serve, and we tweak our services where necessary. Now, our model is one that is used all across the country, and our agency has grown from one with only 16 employees that was in debt, into an $18 million agency with over 250 employees, serving over 25,000 people annually.
K: That’s such a wonderful success story! One of the things that NADAP is known for is implementation of efficient and effective care coordination/care management services. Can you talk a little about how NADAP became such a leader in that arena?
J: In the early 2000s, New York State was spending over $50 billion in Medicaid. At the time, those with substance use disorders accounted for 20% of those on Medicaid, but for 60% of the cost. In 2007, NADAP seized the opportunity to operate a Managed Addiction Treatment Services (MATS) program using an Intensive Case Management (ICM) model, which reduced the Medicaid expenditures for our clients by 62% (with pre- and post-evidence to back these outcomes up). As a result of its success, the state granted NADAP a Medicaid license and rolled our MATS program into Health Homes, with incentives to convert it into a successful Care Coordination Program, which it later became.
K: What do you think is the biggest impact care coordination has on behalf of clients?
J: For the majority of those living with SUD, we see that their addiction often derails their ability to address their other issues related to health and mental health. So for example, when one is chasing illicit drugs, they no longer pay attention to taking their appropriate medication for their heart disease or their psychotropic medications. In addition, sometimes when these medications are blended, this causes individuals to decompensate. Because these issues often co-occur, coordination between services and sectors is critical. Care coordination supports clients to access the best care for their chronic illnesses and reduces needless services and appointments by referring them to an appropriate team of behavioral and primary care specialists to meet their specific needs. In addition to providing more effective care, care coordination reduces cost by eliminating needless duplications in services and by reducing hospitalizations and emergency room use.
K: It seems that Care Coordination services fit within today’s landscape of Affordable Care Act implementation and movement to managed care quite well.
J: Care coordination is truly the common denominator throughout all aspects of the ACA and the triple aim of better quality care, better health, and reduced cost. Achieving reductions in health care costs while improving the overall health of the general public can only be done by implementing coordinated methods of care that reduce redundancies and streamline individuals towards the best affordable care. With that, unnecessary hospitalizations and a reduction in emergency room visits will be achieved. Coordinated Care should be synonymous with Managed Care. Managed Care Organizations (MCOs) are looking to save money and improve outcomes. This can only be done by having Coordinated Care throughout all of a person’s behavioral and primary care referral processes. In this new environment, providers are going to be paid for outcomes (rather than services), and care coordination is an effective strategy to provide the best resources to clients to achieve the goal.
K: If you were to pick the three "essential" principles of effective care coordination, what would they be?
J: The three essential principles would first include a strong outreach and engagement component. Next, it’s important to develop an appropriate team of primary and behavioral health care specialists to tap into on behalf of clients in order to treat their specific chronic conditions. And third, coordinating the referrals to care for all participants and appropriately documenting the process and outcomes of all the related activities across multiple databases and in an in-house proprietary database that can used for "best practices" research and for future performance evaluations.
K: Do you have any advice for organizations looking to move into this "new world" driven by health care reform?
J: I would advise all organizations not to just sit back and wait for the changes to come that will force them into action. They should develop relationships with organizations that are in the forefront of change and that can assist them in improving their services so that they can adapt to the new demands ahead. This may include linking up with Care Coordination providers who understand the requirements of the MCOs in this new arena and who can provide the guidance and support to make the necessary changes that are needed to survive. In addition, agencies should join and become active in the appropriate associations and coalitions within their fields that focus on the changes required under the ACA. The combined knowledge shared by these groups can guide them into the future and allow them to act with more clout in negotiating relationships with the MCOs.