The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement

ABSTRACT

Health care insurance plans covering treatment for substance use disorders (SUD) offer a wide range of benefits. Distinctions between health plan benefits are confusing, and consumers making selections may not adequately understand the characteristics or significance of the choices they have. The California Society of Addiction Medicine sought to help consumers make informed decisions about plan selections by providing education on the standard of care for SUD and presenting findings from an expert analysis of selected health plans. We developed an assessment framework, based on criteria endorsed by the American Society of Addiction Medicine, to rate the quality of SUD treatment benefits offered by a sample of insurance plans. We convened an expert panel of physicians to rate 16 policies of 10 insurance providers across seven categories. Data from published resources for 2014 insurance plans were extracted, categorized, and rated. The framework and ratings were summarized in a consumer-facing white paper. We found significant heterogeneity in benefits across comparable plans, as well as variation in the characterization and clarity of published services. This article presents findings and implications of the project. There is a pressing need to define requirements for SUD benefits and to hold health plans accountable for offering quality services in accordance with those benefits.

KEYWORDS:

• ACA
• addiction
• benefits
• consumer
• insurance
• parity

Acknowledgments

This project would not have been possible without the contribution of the members and support staff for the CSAM Scorecard Taskforce: Sharone Abramowitz, Anthony Albanese, Peter Banys, Lauren Creamer, Steven Eickelberg, Monika Koch, Robin Koltenuk, Jean Marsters, Karen Miotto, Kerry Parker, David Pating, Mary Thomas, Christy Waters, Jeffery Wilkins, and Romana Zvereva.