A Collaborative Business Model for Level III.1 ATTC Leadership Institute

Christina Trenton LCSW-C, CAC-AD Executive Director, W House Member-Maryland Association of Alcohol & Drug Continuing Care Facilities Association Mentor: Dr. Peter Luongo-Director Maryland Alcohol and Drug Abuse Administration

Individual Leadership Competencies Addressed by this Project Strategic Thinking Decisiveness-Risk Taking Problem Solving

Project Goal: To create an entrepreneurial response for Level III.1 in a competitive market place.

Recent Research… The Journal of Substance Abuse Treatment in October’s issue, published McClellan & Kimberly’s article “The Business of Addiction Treatment: A Research Agenda” which discusses the challenges facing the nation’s substance abuse treatment system

Recent Research …. Corredoira and Kimberly wrote “Industry Evolution through Consolidation: Implications for Addictions Treatment”. They cite major realignments in other industries to argue that the business of addictions treatment is likely to be transformed by a period of consolidation, in which a number of small, independent programs will be acquired by larger, better-capitalized and managerially more sophisticated enterprises. Not known is whether an industry-wide consolidation will lead to quality improvement through increased competition among larger providers, or – if the larger providers are publicly traded – quality will be subordinated to pressures to maintain or increase earnings and share price.

Conditions Existing Currently Most halfway houses (Level III.1) in the State of Maryland are free standing entities Most are small (less than 30 beds) All struggle with cost containment All struggle with diversifying funding streams

A Change in mindset…. How does a small treatment agency respond strategically to the market forces discussed in the research? First and foremost we must change the way we think of ourselves! WE ARE A BUSINESS We MUST think like a BUSINESS

How do we do this? Be confident that what is done on the management level is going to help at the client level In the field of addiction we have succumbed to the lazy undisciplined search for a silver bullet Be relentlessly curious!

What if ? Core Values and Core Purpose is retained? Cultural and Operating Practices change?

Implementation of Entrepreneurial Exploration MAADCCF convened a work group Processes were identified for change and re- engineering Exploration and development of collaborative business plan and strategic partnerships Areas for technical assistance identified Creation of clinically relevant protocols Creation of economically relevant business practices

What if ???? Partnership models were blended to create an entrepreneurial way of doing business? The risk of program closure could be minimized if collectively this level of care worked together to create a co-opt business model. This model can be mixed and matched to create both regional and statewide consortiums

What if ??? Business practices were re-engineered for collaboration? This could include collective purchasing of Health Insurance Liability, Directors & Officers, Workman’s Comp, Vehicle Insurance Criminal Background costs Purchasing-Food, Office & Janitorial Supplies (negotiation of prices, triple the volume for the vendor)

What if ?? The creation of a labor pool of counselors (PRN) Could plug gaps regionally in service delivery Could be used during times of high census Could be used during times of illness, vacation The nursing and social work field have done this, why haven’t we?

What if ? A labor pool of specialty positions was created to serve a region Clinical Supervisor Family Counselor Trauma Specialist Vocational Specialist

Wrap up This project centered on how to answer the question of how small community based providers like halfway houses who don’t provide a range of services can become and remain competitive in a changing market place.

Conclusion Halfway houses can remain financially viable through the creation of collaborative business practices. This can include the coordination of administrative and fiscal functions which would allow halfway houses to qualify for contracts that usually go to larger, more diversified vendors. This model also gives participating agencies a broader reach; greater service impact in terms of continuity of care and wraparound services. Overall, the creation of an entrepreneurial business model for Level III.1 providers will increase competitiveness in the behavioral health care market.