Directors' perceptions of the effects of managed care in outpatient substance abuse treatment

Tailoring of outpatient substance abuse treatment to women, 1995-2005

BACKGROUND

Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options.

OBJECTIVES

This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to identify unit and contextual factors associated with these practices.

RESEARCH DESIGN

Data were from 2 waves of a national OSAT unit survey (N = 618 in 1995, N = 566 in 2005). Comparisons of weighted means between waves indicate which practices changed over time. Multiple logistic regressions with generalized estimating equations test associations between unit and contextual attributes and tailoring to women.

MEASURES

Tailoring to women was measured as availability of prenatal care, child care, single sex therapy, and same sex therapists, and the percentage of staff trained to meet female clients' needs.

RESULTS

Two measures of tailoring to women declined significantly between 1995 and 2005: availability of single sex therapy (from 66% to 44% of units) and percent of staff trained to work with women (from 42% to 32% of units). No aspect of tailoring to women became more common. Proportion of female clients, total number of clients, methadone status, and private and government managed care were associated with higher odds of tailoring to women. For-profit facilities, which became more prevalent during the study period, had lower odds than other units of tailoring treatment to women.

CONCLUSIONS

Some key aspects of OSAT tailoring to women decreased significantly in the last decade. Managed care contracts may offer 1 mechanism for counteracting these trends.

Managed Care, Inter-agency Linkages, and Outpatient Substance Abuse Treatment

: Although treatment of co-occurring behavioral and physical health problems could be facilitated by the linkages between health care providers, it is uncertain how such inter-agency linkages are affected by managed care. We used a sample of 167 service linkages to examine the effects of managed care arrangements on inter-agency communication, coordination, and perceived effectiveness. These linkages were identified based on interviews with 62 outpatient substance abuse treatment units in 2000. Results indicate that frequency of communication and inter-agency coordination are positively related to several managed care arrangements and may moderate the relationships between managed care arrangements and perceived effectiveness.

The impact of managed care on publicly funded outpatient adolescent substance abuse treatment: service use and six-month outcomes in Oregon and Washington

This study assessed the impact of managed care on publicly funded adolescent substance abuse treatment by comparing differences in service utilization and outcomes across prospective samples from two states: Oregon, which uses managed care practices in service financing and delivery, and Washington, which does not. One hundred and six adolescents from Washington and 94 from Oregon, who entered outpatient substance abuse treatment in 1998 and 1999, completed self-report surveys about their substance use before and after receiving treatment (follow-up rate = 75 percent). In addition, clinical chart reviews conducted at the 6-month follow-up assessed the type and amount of treatment these adolescents received during the study period. It was found that service utilization and treatment outcomes were comparable across the two state samples. The evidence presented here suggests that managed care is capable of delivering substance abuse treatment services of comparable quality to state-administered substance abuse treatment services.

Managed care and access to substance abuse treatment services

Using nationally representative data from 1995 and 2000, this study examined how managed care penetration and other organizational characteristics were related to accessibility to outpatient substance abuse treatment. At an organizational level, access was measured as the percentage of clients unable to pay for services; the percentage of clients receiving a reduced fee; and the percentage of clients with shortened treatment because of their inability to pay. Treatment units with both relatively low and relatively high managed care penetration were more likely to support access to care; these units provided care to higher percentages of clients unable to pay and were less likely to shorten treatment because of client inability to pay. Treatment units with midrange managed care penetration were least likely to support access to care. The complexity of managing in an environment of conflicting incentives may reduce the organization's ability to serve those with limited financial means.

Managed behavioral health care: an instrument to characterize critical elements of public sector programs

OBJECTIVE

To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and "unmanaged" care and among managed care arrangements.

STUDY DESIGN

The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers.

DATA COLLECTION METHODS

Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants.

PRINCIPAL FINDINGS

This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care.

CONCLUSIONS

If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary.

Using cost and financing instruments for economic evaluation of substance abuse treatment services

Standardized economic evaluation instruments are an important tool in the analysis of change and performance of addiction treatment. Nevertheless, compared to other health care sectors, economic evaluation of addiction treatment is still rare. The present paper proposes two comprehensive economic evaluation instruments that are methodologically sound and that meet the objectives of comprehensiveness, standardization, and comparability. The Drug Abuse Treatment Cost Analysis Program (DATCAP) can be used to estimate the economic cost of treatment services; the Drug Abuse Treatment Financing Analysis Program (DATFin) is a companion instrument and analyzes the complexity and change of treatment financing. This paper outlines the contents of each instrument and, for illustrative purposes, presents results from several case studies. Suggestions for updates and enhancements for each instrument are also discussed.

Managed care and outpatient substance abuse treatment intensity

This study examines the extent to which managed care behavioral controls are associated with treatment intensity in outpatient substance abuse treatment facilities. Data are from the 1995 National Drug Abuse Treatment System Survey, a nationally representative survey that includes over 600 provider organizations with a response rate of 86%. Treatment intensity is measured in three ways: (1) the number of months clients spend in outpatient drug treatment, (2) the number of individual treatment sessions clients receive over the course of treatment, and (3) the number of group treatment sessions clients receive over the course of treatment. After accounting for selection bias and controlling for market, organization, and client characteristics, there is no significant relationship between the scope of managed care oversight and treatment intensity. However, the stringency of managed care oversight activities is negatively associated with the number of individual and group treatment sessions received over the course of treatment.