Leadership Interview: Daniel Darting, CEO, Signal Behavioral Health Network

Daniel Darting is the CEO of Signal Behavioral Health Network, previously serving as its director of information technology. Signal provides substance abuse disorder services in three regions in Colorado, including western Larimer County. Darting serves on the board of the National Council for Behavioral Health, the Colorado Providers Association, and Colorado Behavioral Healthcare Council and numerous stakeholder groups in Colorado. 
 
Ascent: Your organization’s work is in substance use disorder (SUD) health care interventions. In what way do SUD services have an impact on health care, in terms of outcomes for clients and savings in the system? 
 
Darting: When you look at the metrics around the cost of SUD to health care, to society, and the broader economic impact, it’s substantial. A 2015 study estimated $442 billion in unnecessary health care, economic and criminal justice cost related to SUD. That’s 2 percent of GDP—a huge number. 
 
Here in Colorado, the Department of Health Care Policy and Financing estimates there’s something on the order of $63 million in potential savings just within Medicaid related to appropriate SUD care. That’s a really big number, too. 
 
If you’re going to target high health care costs, SUD appears to be the place to intervene with better health care delivery. The way I interpret that number is the cost of care that is not delivered at the time it’s needed. When care isn’t available when the client needs it, costs can escalate—like ER visits that didn’t need to happen had someone received an early intervention. 
 
Early and preventive interventions for SUD are powerful. We see a lot of investment in the treatment system, which is the most acute intervention, but very little for prevention and recovery. Often, when a client completes an inpatient admission intervention, they don’t have supports in the community they need, so they may have to return to treatment. That’s why the societal and personal costs are so high.
 
Ascent: There has been a lot more attention paid to behavioral health, and SUD in particular, by policymakers, health plans and communities. How has that affected the system and consumer access? 
 
Darting: There’s been a tremendous amount of additional interest and expression of support within the last five years, largely driven by the opioid crisis. We had a substance abuse crisis before that, but the acuity has been higher with opioids. 
 
That’s helpful in the sense that some of the barriers or resistance to interventions are less common, there’s more support, and we don’t have as much stigma. But there are still hurdles to get over, and stigma remains. 
 
There are all manner of ways to address this at local, state and federal levels, but at this time, it feels disconnected. A lot of new funding streams are grant-based. We’re grateful for that, but we’re missing a level of sophistication that will make funding for SUD look more like funding for health care. 
 
In Colorado’s Medicaid program, outpatient SUD benefits are covered, and the state is moving forward on residential care as well. But commercial insurance coverage probably needs to be more uniform. Investments in recovery services—the general emphasis that health plans pay to support long-term wellness—need to be applied to SUD as well. With respect to understanding this as a chronic disease, it’s still in its infancy in terms of societal acceptance, and that informs policymakers. We’re deeply grateful for what we’ve seen in the last few years, but it’s also just the start.
 
Ascent: What’s next? 
 
Darting: Between 50 to 60 percent of those who receive treatment for SUD enter long-term recovery. That’s very much in line with other chronic diseases. But the difference for SUD is that fewer people can access needed services. There is a capacity need for both preventive and intervention services. We’re seeing acknowledgement of that, and it’s encouraging, but there’s a lot of work in front of us. 
 
I think the natural evolution of the system of care is integration of behavioral and SUD services with the rest of health care delivery, in partnership with organizations like Rocky Mountain Health Plans. They have RMHP Prime, which provides full health coverage integrated across all types of need. If you look at potentially avoidable cost, doesn’t it make sense to incentivize early treatment and prevention over more acute and expensive health interventions? To do that, you need to link those services. SUD care is specialty care, but having SUD providers integrated with local primary care practices seems like the direction we need to go.