1
|
Nong T, Hodgkin D, Trang NT, Shoptaw SJ, Li MJ, Hai Van HT, Le G. A review of factors associated with methadone maintenance treatment adherence and retention in Vietnam. Drug Alcohol Depend 2023; 243:109699. [PMID: 36603363 PMCID: PMC9851667 DOI: 10.1016/j.drugalcdep.2022.109699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Starting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam. METHODS A systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods. RESULTS Adherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors. CONCLUSIONS The literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes.
Collapse
Affiliation(s)
- Thuong Nong
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America.
| | - Dominic Hodgkin
- The Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA 02453, the United States of America
| | - Nguyen Thu Trang
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
| | - Steven J Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | - Michael J Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, the United States of America
| | | | - Giang Le
- Center for Training and Research on Substance Abuse and HIV, Hanoi Medical University, Hanoi, Viet Nam
| |
Collapse
|
2
|
Satre DD, Palzes VA, Young-Wolff KC, Parthasarathy S, Weisner C, Guydish J, Campbell CI. Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. J Subst Abuse Treat 2020; 118:108097. [PMID: 32972648 DOI: 10.1016/j.jsat.2020.108097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy. METHODS We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood. RESULTS Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment. CONCLUSIONS Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves.
Collapse
Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Constance Weisner
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, United States of America
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| |
Collapse
|
3
|
Xu J, Wang J, King M, Liu R, Yu F, Xing J, Su L, Lu M. Rural-urban disparities in the utilization of mental health inpatient services in China: the role of health insurance. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:377-393. [PMID: 29589249 PMCID: PMC6223725 DOI: 10.1007/s10754-018-9238-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 03/17/2018] [Indexed: 05/28/2023]
Abstract
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China's on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. This retrospective study used 10 years (2005-2014) of hospital electronic health records from the Shandong Center for Mental Health and the DaiZhuang Psychiatric Hospital, two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Consistent with the existing literature, our study suggests that increasing insurance schemes' reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.
Collapse
Affiliation(s)
- Junfang Xu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jian Wang
- Center for Health Economic Experiments and Public Policy, Department of Social Medicine and Administration, School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, Shandong, China.
| | - Madeleine King
- School of Public Policy and Management, Tsinghua University, Beijing, China
| | - Ruiyun Liu
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Fenghua Yu
- Shandong Health and Family Planning Commission, Jinan, Shandong, China
| | - Jinshui Xing
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Lei Su
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Canada
| |
Collapse
|
4
|
Grogan CM, Andrews C, Abraham A, Humphreys K, Pollack HA, Smith BT, Friedmann PD. Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications. Health Aff (Millwood) 2018; 35:2289-2296. [PMID: 27920318 DOI: 10.1377/hlthaff.2016.0623] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treatment and opioid use disorder medications across the United States. Many states did not cover all levels of care required for effective substance use disorder treatment or medications required for effective opioid use disorder treatment as defined by American Society of Addiction Medicine criteria, which could result in lack of access to needed services for low-income populations.
Collapse
Affiliation(s)
- Colleen M Grogan
- Colleen M. Grogan is a professor at the School of Social Service Administration, University of Chicago, in Illinois
| | - Christina Andrews
- Christina Andrews is an assistant professor at the College of Social Work, University of South Carolina, in Columbia
| | - Amanda Abraham
- Amanda Abraham is an assistant professor in the Department of Public Administration and Policy at the University of Georgia, in Athens
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences in the Department of Psychiatry at the Stanford School of Medicine, in California
| | - Harold A Pollack
- Harold A. Pollack is the Helen Ross Professor at the School of Social Service Administration, University of Chicago
| | - Bikki Tran Smith
- Bikki Tran Smith is a doctoral student at the School of Social Service Administration, University of Chicago
| | - Peter D Friedmann
- Peter D. Friedmann is chief research officer at Baystate Health, in Springfield, Massachusetts
| |
Collapse
|
5
|
Schmidt EM, Gupta S, Bowe T, Ellerbe LS, Phelps TE, Finney JW, Humphreys K, Trafton J, Vanneman ME, Harris AHS. Predictive Validity of Outpatient Follow-up After Detoxification as a Quality Measure. J Addict Med 2018; 11:205-210. [PMID: 28282324 DOI: 10.1097/adm.0000000000000298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Care coordination for substance use disorder (SUD) treatment is a persistent challenge. Timely outpatient follow-up after detoxification from alcohol and opiates is associated with improved outcomes, leading some care systems to attempt to measure and incentivize this practice. This study evaluated the predictive validity of a 7-day outpatient follow-up after detoxification quality measure used by the Veterans Health Administration (VHA). METHODS A national sample of patients who received detoxification from alcohol or opiates (N = 25,354) was identified in VHA administrative data. Propensity score-weighted mixed-effects regressions modeled associations between receiving an outpatient follow-up visit within 7 days of completing detoxification and patient outcomes, controlling for facility-level performance and clustering of patients within facilities. RESULTS Baseline differences between patients who did (39.6%) and did not (60.4%) receive the follow-up visit were reduced or eliminated with propensity score weighting. Meeting the quality measure was associated with significantly more outpatient treatment for SUD (b = 1.07 visits) and other mental health conditions (b = 0.58 visits), and higher inpatient utilization for SUD (b = 0.75 admissions) and other mental health conditions (b = 0.76 admissions). Notably, meeting the quality measure was associated with 53.3% lower odds of 2-year mortality (P < 0.001 for all). CONCLUSIONS These findings support the predictive validity of 7-day follow-up after detoxification as a care coordination measure. Well-coordinated care may be associated with higher outpatient and inpatient utilization, and such engagement in care may be protective against mortality in people who receive detoxification from alcohol or opiates.
Collapse
Affiliation(s)
- Eric M Schmidt
- Center for Innovation to Implementation (Ci2i),Veterans Affairs Palo Alto Health Care System (EMS, SG, TB, LSE, TEP, JWF, KH, JT, MEV, AHSH); Center for Health Policy/Primary Care and Outcomes Research (CHP/PCOR), and the Department of Surgery, Stanford University (EMS, MEV, AHSH); and Program Evaluation and Resource Center, Office of Mental Health Operations, Veterans Affairs Central Office (JT)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Running Bear U, Beals J, Novins DK, Manson SM. Alcohol detoxification completion, acceptance of referral to substance abuse treatment, and entry into substance abuse treatment among Alaska Native people. Addict Behav 2017; 65:25-32. [PMID: 27705843 PMCID: PMC5140722 DOI: 10.1016/j.addbeh.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification). METHODS The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit. Three multiple logistic regression models estimated the adjusted associations of each outcome separately with demographic/psychosocial characteristics, clinical characteristics, use related behaviors, and health care utilization. RESULTS Seventy-five percent completed detoxification treatment. Higher global assessment functioning scores, longer lengths of stay, and older ages of first alcohol use were associated with completing detoxification. A secondary drug diagnosis was associated with not completing detoxification. Thirty-six percent accepted a referral to substance abuse treatment following detoxification. Men, those with legal problems, and those with a longer length of stay were more likely to accept a referral to substance abuse treatment. Fifty-eight percent had a confirmed entry into a substance abuse treatment program at discharge. Length of stay was the only variable associated with substance abuse treatment entry. CONCLUSIONS Services like motivational interviewing, counseling, development of therapeutic alliance, monetary incentives, and contingency management are effective in linking patients to services after detoxification. These should be considered, along with the factors associated with each point on the continuum of care when linking patients to follow-up services.
Collapse
Affiliation(s)
- Ursula Running Bear
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States.
| | - Janette Beals
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States
| | - Douglas K Novins
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States
| | - Spero M Manson
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO 80045, United States
| |
Collapse
|
7
|
Ritter A, Hull P, Berends L, Chalmers J, Lancaster K. A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment. Addict Behav 2016; 60:228-34. [PMID: 27174218 DOI: 10.1016/j.addbeh.2016.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/15/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to establish a conceptual schema for government purchasing of alcohol and other drug treatment in Australia which could encompass the diversity and variety in purchasing arrangements, and facilitate better decision-maker by purchasers. There is a limited evidence base on purchasing arrangements in alcohol and drug treatment despite the clear impact of purchasing arrangements on both treatment processes and treatment outcomes. METHODS The relevant health and social welfare literature on purchasing arrangements was reviewed; data were collected from Australian purchasers and providers of treatment giving detailed descriptions of the array of purchasing arrangements. Combined analysis of the literature and the Australian purchasing data resulted in a draft schema which was then reviewed by an expert committee and subsequently finalised. RESULTS The conceptual schema presented here was purpose-built for alcohol and other drug treatment, with its overlap between health and social welfare services. It has three dimensions: 1. The ways in which providers are chosen; 2. The ways in which services are paid for; and 3. How price is managed. Distinguishing between the methods for choosing providers (such as competitive or individually negotiated processes) from the way in which organisations are paid for their provision of treatment (such as via a block grant or payment for activity) provides conceptual clarity and enables closer analysis of each mechanism. CONCLUSIONS Governments can improve health and wellbeing by making informed decisions about the way they purchase and fund alcohol and other drug treatment. Research comparing different purchasing arrangements can provide a vital evidence-base to inform funders; however a first step is to accurately and consistently categorise current approaches against a typology or conceptual schema.
Collapse
|
8
|
Timko C, Below M, Schultz NR, Brief D, Cucciare MA. Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review. J Subst Abuse Treat 2015; 52:31-9. [DOI: 10.1016/j.jsat.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
|
9
|
Burke BT, Miller BF, Proser M, Petterson SM, Bazemore AW, Goplerud E, Phillips RL. A needs-based method for estimating the behavioral health staff needs of community health centers. BMC Health Serv Res 2013; 13:245. [PMID: 23816353 PMCID: PMC3750356 DOI: 10.1186/1472-6963-13-245] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Federally Qualified Health Centers are expanding to increase access for millions of more Americans with a goal of doubling capacity to serve 40 million people. Health centers provide a lot of behavioral health services but many have difficulty accessing mental health and substance use professionals for their patients. To meet the needs of the underserved and newly insured it is important to better estimate how many behavioral health professionals are needed. METHODS Using health center staffing data and behavioral health service patterns from the 2010 Uniform Data System and the 2010 National Survey on Drug Use and Health, we estimated the number of patients likely to need behavioral health care by insurance type, the number of visits likely needed by health center patients annually, and the number of full time equivalent providers needed to serve them. RESULTS More than 2.5 million patients, 12 or older, with mild or moderate mental illness, and more than 357,000 with substance abuse disorders, may have gone without needed behavioral health services in 2010. This level of need would have required more than 11,600 full time providers. This translates to approximately 0.9 licensed mental health provider FTE, 0.1 FTE psychiatrist, 0.4 FTE other mental health staff, and 0.3 FTE substance abuse provider per 2,500 patients. These estimates suggest that 90% of current centers could not access mental health services or provide substance abuse services to fully meet patients' needs in 2010. If needs are similar after health center expansion, more than 27,000 full time behavioral health providers will be needed to serve 40 million medical patients, and grantees will need to increase behavioral health staff more than four-fold. CONCLUSIONS More behavioral health is seen in primary care than in any other setting, and health center clients have greater behavioral health needs than typical primary care patients. Most health centers needed additional behavioral health services in 2010, and this need will be magnified to serve 40 million patients. Further testing of these workforce models are needed, but the degree of current underservice suggests that we cannot wait to move on closing the gap.
Collapse
Affiliation(s)
- Bridget Teevan Burke
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Benjamin F Miller
- Department of Family Medicine, University of Colorado Denver School of Medicine, Mail Stop F496 Academic Office 1, 12631 East 17th Avenue, Room 3403, Aurora, CO 80045, USA
| | - Michelle Proser
- National Association of Community Health Centers, 1400 I Street, NW, Suite 910, Washington, DC 20005, USA
| | - Stephen M Petterson
- The Robert Graham Center, 1133 Connecticut Ave NW, Suite 1100, Washington, DC 20036, USA
| | - Andrew W Bazemore
- The Robert Graham Center, 1133 Connecticut Ave NW, Suite 1100, Washington, DC 20036, USA
| | - Eric Goplerud
- Substance Abuse, Mental Health and Criminal Justice Studies, NORC at the University of Chicago, 4350 East West Highway 8th Floor, Bethesda, MD 20814, USA
| | - Robert L Phillips
- The American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY 40511-1247, USA
| |
Collapse
|
10
|
Bouchery EE, Harwood HJ, Dilonardo J, Vandivort-Warren R. Type of health insurance and the substance abuse treatment gap. J Subst Abuse Treat 2011; 42:289-300. [PMID: 22119184 DOI: 10.1016/j.jsat.2011.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 08/28/2011] [Accepted: 09/14/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Most individuals reporting symptoms consistent with substance use disorders do not receive care. This study examines the correlation between type of insurance coverage and receipt of substance abuse treatment, controlling for other observable factors that may influence treatment receipt. METHOD Descriptive and multivariate analyses are conducted using pooled observations from the 2002-2007 editions of the National Survey on Drug Use and Health. The likelihood of treatment entry is estimated by type of insurance coverage controlling for personal characteristics and characteristics of the individual's substance use disorder. RESULTS Multivariate analyses that control for type of substance and severity of disorder (dependence vs. abuse) find that those with Civilian Health and Medical Program of the Uniformed Services/Veterans Affairs, Medicaid only, Medicare only, and Medicare and Medicaid (dual eligibles) have 50% to almost 90% greater odds of receiving treatment relative to those with private insurance. CONCLUSIONS The privately insured population has substantially lower treatment entry rates than those with publicly provided insurance. Additional research is warranted to understand the source of the differences across insurance types so that improvements can be achieved.
Collapse
Affiliation(s)
- Ellen Englert Bouchery
- MathematicaPolicy Research, 600 Maryland Avenue, SW, Suite 550, Washington, DC 20024, USA.
| | | | | | | |
Collapse
|
11
|
Ziller EC, Anderson NJ, Coburn AF. Access to Rural Mental Health Services: Service Use and Out-of-Pocket Costs. J Rural Health 2010; 26:214-24. [DOI: 10.1111/j.1748-0361.2010.00291.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Stein BD, Kogan JN, Sorbero M. Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: rates and duration of subsequent treatment. Drug Alcohol Depend 2009; 104:100-6. [PMID: 19481884 PMCID: PMC2818065 DOI: 10.1016/j.drugalcdep.2009.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 04/08/2009] [Accepted: 04/08/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment. METHODS Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006. RESULTS Slightly less than half (49%) of the sample received follow-up care within 30 days of discharge. Rates of follow-up were significantly higher in individuals with a serious mental illness, and significantly lower in African-American individuals, males, individuals with disabilities, and those who received detoxification without residential treatment. The mean duration of follow-up treatment was 84 days, and was longer among individuals with a serious mental illness and Caucasians. Even after controlling for individuals' sociodemographic and clinical characteristics, there was substantial variation in follow-up rates among discharging providers. CONCLUSION The relatively low rates of follow-up care and relatively brief duration of treatment for many of those who received such follow-up care are concerning in a population receiving substance abuse detoxification or residential treatment. The markedly lower rates among those receiving detoxification alone without subsequent residential treatment and among those without a comorbid serious mental illness suggest that efforts specifically targeting those individuals may be of particular benefit.
Collapse
Affiliation(s)
- Bradley D. Stein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St., Pittsburgh, Pennsylvania 15213,Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
| | - Jane N. Kogan
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St., Pittsburgh, Pennsylvania 15213,Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
| | - Mark Sorbero
- Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Pittsburgh, Pennsylvania 15219
| |
Collapse
|
13
|
Affiliation(s)
- Dahlia K. Remler
- School of Public Affairs, Baruch College, City University of New York, New York, NY, 10010, and Economics Department, The Graduate Center of the City University of New York and National Bureau of Economic Research, New York, NY 10016;
| | - Jessica Greene
- Department of Planning, Public Policy, and Management, University of Oregon, Eugene, Oregon, 97403
| |
Collapse
|
14
|
Horgan CM, Garnick DW, Merrick EL, Hodgkin D. Changes in how health plans provide behavioral health services. J Behav Health Serv Res 2009; 36:11-24. [PMID: 17874188 PMCID: PMC2982768 DOI: 10.1007/s11414-007-9084-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 08/09/2007] [Indexed: 12/28/2022]
Abstract
Health plans appear to be moving toward less stringent management, but it is not known whether behavioral health care arrangements mirror the overall trend. To improve access to and quality of behavioral health services, it is critical to track plans' delivery of these services. This study examined plans' behavioral health care arrangements and changes over time using a nationally representative health plan survey regarding alcohol, drug abuse, and mental health services in 1999 (N = 434, 92% response) and 2003 (N = 368, 83% response). Findings indicate health plans' behavioral health service provision changed significantly since 1999, including a large increase in contracting with managed behavioral health care organizations. Some evidence of loosening administrative controls such as prior authorization implies easier access to services. However, increased prevalence of higher levels of cost sharing suggests financial barriers have grown. These changes have important implications for enrollees seeking care and for providers working to meet patients' needs.
Collapse
Affiliation(s)
- Constance M Horgan
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA.
| | | | | | | |
Collapse
|
15
|
Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis 2007; 25:91-103. [PMID: 17088229 DOI: 10.1300/j069v25n04_09] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The limited availability of medication-assisted treatment has created a treatment gap leaving many opioid dependent individuals without access to appropriate treatment. Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 are presented. During the first year, an estimated 63,204 opioid dependent patients were treated with buprenorphine; many were dependent on prescription opioids and were new to drug treatment. Prescribing physicians reported high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion. However, many waivered physicians had not provided buprenorphine treatment. Prescribers identified challenges such as induction logistics, recordkeeping requirements, the 30-patient limit, DEA involvement, and limited patient compliance. Buprenorphine treatment could potentially reduce the treatment gap by providing safe and effective treatment for opioid dependence and by attracting patients who do not typically seek care at opioid treatment programs.
Collapse
|
16
|
Mark TL, Vandivort-Warren R, Montejano LB. Factors affecting detoxification readmission: Analysis of public sector data from three states. J Subst Abuse Treat 2006; 31:439-45. [PMID: 17084799 DOI: 10.1016/j.jsat.2006.05.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 05/12/2006] [Accepted: 05/15/2006] [Indexed: 11/21/2022]
Abstract
The objective of this study was to understand the rate of detoxification readmissions and the factors associated with readmission within a public sector population. The study sample was drawn from an integrated database that includes Medicaid and state mental health and substance abuse agency data from three states (Delaware, Oklahoma, and Washington) for 1996-1998. Clients with at least one state agency-sponsored detoxification event in 1996 or 1997 were included in the study. Twenty-seven percent of the sample was readmitted for detoxification within 1 year of their index detoxification. Clients who received two or more substance-abuse-related services within 30 days of their index detoxification were less likely to be readmitted and had a longer time until their second detoxification admission. Detoxification readmission is common in the public sector. Engaging patients in treatment following detoxification may reduce readmission rates and time to readmission.
Collapse
|
17
|
Temporal trends in rates of dual diagnoses at a Canadian addictions hospital over a five-year period. Ir J Psychol Med 2006; 23:10-16. [PMID: 30290561 DOI: 10.1017/s0790966700009393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Dual diagnosis refers to co-occurring substance use and psychiatric disorders. The principal aims of this investigation were two-fold: 1) to identify aspects of patients' drug use and prior treatment histories associated with their receiving a dual diagnosis upon admission to the Donwood Institute, a residential drug treatment facility located in Toronto, Canada; 2) to track temporal trends in the rates of diagnosed comorbidities over a five-year period at this same institution. METHODS We conducted an analysis of the intake assessment forms and hospital records of 159 patients who had been admitted to a drug treatment facility during the month of September for each of the years between 1998 and 2002 inclusive. Comparisons were made between patients who had received a psychiatric diagnosis on admission and patients who had received no such diagnosis. We then employed logistic regression analyses to explore the relationship of the variable psychiatric diagnosis on admission to other patient variables. RESULTS Among the patients studied in our sample, those receiving psychotherapy or taking prescription psychotropic medication at the time of their admission as well as patients whose primary problem substance was cannabis or who had been previously admitted to the treatment facility were significantly more likely to have received a psychiatric diagnosis on admission, in spite of our finding that several patients receiving psychotherapy or taking at least one psychotropic medication did not receive a psychiatric diagnosis on admission. CONCLUSIONS Whilst our data indicate that psychiatric comorbidity is common among individuals in treatment for substance use disorders at the Donwood Institute, it is possible that some individuals with psychiatric illness in our sample were not diagnosed as such when presenting for treatment of their substance use difficulties. Moreover, temporal tracking of rates of dual diagnoses did not reveal a consistent increase during the period studied.
Collapse
|
18
|
Schmidt LA, Weisner CM. Private insurance and the utilization of chemical dependency treatment. J Subst Abuse Treat 2005; 28:67-76. [PMID: 15723734 DOI: 10.1016/j.jsat.2004.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 10/13/2004] [Accepted: 10/28/2004] [Indexed: 10/25/2022]
Abstract
This study examines how different types of health coverage influence the likelihood of entering treatment for an alcohol problem, and the extent that people in treatment are able to use their insurance to help cover the costs of care. Survey data are analyzed from a sample of problem drinkers drawn from the general population and chemical dependency treatment programs in the same community. We find that, in comparison to being on Medicaid and being uninsured, having private coverage does not significantly alter the odds of treatment entry. Being in a private managed care plan, as compared to traditional indemnity coverage, also does not appear to impact the chances of treatment entry. However, having private coverage, as compared to being on Medicare, doubles the odds of treatment entry. For problem drinkers who obtain treatment, those with private coverage are as or more likely than other insured groups to report that insurance helped to pay treatment expenses. Even so, 10% of those privately insured report having paid for all of their treatment costs out of pocket. We conclude that, while prior studies have rarely found that having insurance significantly impacts alcohol treatment entry, the type of coverage one possesses may matter in some cases. Our results concerning Medicare coverage may point to potential problems with making treatment affordable to some problem drinkers outside the private insurance system.
Collapse
Affiliation(s)
- Laura A Schmidt
- Alcohol Research Group, Public Health Institute, Berkeley, CA 94709, USA.
| | | |
Collapse
|
19
|
Lo Sasso AT, Lyons JS. The sensitivity of substance abuse treatment intensity to co-payment levels. J Behav Health Serv Res 2004; 31:50-65. [PMID: 14722480 DOI: 10.1007/bf02287338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study exploits variation in co-payment levels among different contractual arrangements within a regional managed behavioral health care organization to estimate the relationship between co-payment levels for substance use treatment services and the intensity of substance use treatment. The substance use treatment benefits involved a range of co-payment levels across nearly 400 employers during the years 1993 through 1998. Multiple regression techniques were used to estimate the effect of co-payment levels on treatment intensity. The results indicate that co-payment levels had a significant negative effect on outpatient and inpatient substance use treatment. For outpatient treatment the effect on intensity implied a co-payment elasticity of -0.18, implying that moving from a $10 co-payment to a $20 co-payment would result in, for example, a reduction from 5 to 4 outpatient visits per episode. However, the effect was larger for persons with combined alcohol and drug use disorders, as they exhibited a co-payment elasticity of -0.27. For inpatient days, the co-payment elasticity was considerably smaller at -0.017. Given the benefits of maintaining persons with substance use disorders in treatment, employers may have an incentive to take steps to minimize the barriers to treatment.
Collapse
Affiliation(s)
- Anthony T Lo Sasso
- Institute for Policy Research, Northwestern University, 2040 Sheridan Rd, Evanston, IL 60208, USA.
| | | |
Collapse
|
20
|
The Sensitivity of Substance Abuse Treatment Intensity to Co-Payment Levels. J Behav Health Serv Res 2004. [DOI: 10.1097/00075484-200401000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Alexander JA, Lemak CH, Campbell CI. Changes in managed care activity in outpatient substance abuse treatment organizations, 1995-2000. J Behav Health Serv Res 2003; 30:369-81. [PMID: 14593661 DOI: 10.1007/bf02287425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using nationally representative data from 1995 and 2000, this study examines trends in managed care penetration and activity among outpatient drug treatment organizations in the United States. Further, it investigates how managed care activity varies across different types of treatment providers and for public and private managed care programs. Overall, managed care activity has increased, with a greater proportion of units having managed care arrangements and a larger percentage of clients covered by managed care. In general, public managed care activity has increased and private managed care activity has decreased. Treatment providers report that they have fewer managed care arrangements, which may reflect consolidation in the managed behavioral care sector. Finally, growth in managed care among outpatient substance abuse treatment units affiliated with hospitals and mental health centers may signal a preference for providers that can effectively link substance abuse treatment with medical and social service provision, or, alternatively, that linkages with such organizations may provide the size necessary to assume the risks associated with managed care contracts.
Collapse
Affiliation(s)
- Jeffrey A Alexander
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Mich., USA
| | | | | |
Collapse
|
22
|
Changes in Managed Care Activity in Outpatient Substance Abuse Treatment Organizations, 1995???2000. J Behav Health Serv Res 2003. [DOI: 10.1097/00075484-200310000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Mark TL, Dilonardo JD, Chalk M, Coffey R. Factors associated with the receipt of treatment following detoxification. J Subst Abuse Treat 2003; 24:299-304. [PMID: 12867203 DOI: 10.1016/s0740-5472(03)00039-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper examines the determinants of whether an individual received continuing treatment/rehabilitation services 30 days after receiving inpatient substance abuse detoxification. Data came from 1997-1999 employer health insurance claims. Only 49.4% of detoxification episodes were followed by continuing mental health or substance abuse treatment within 30 days after discharge. Some of the factors positively associated with receiving continuing treatment after receiving detoxification included: female gender, being in a behavioral health carve-out plan, and lower cost-sharing requirements for an outpatient substance abuse visit.
Collapse
Affiliation(s)
- Tami L Mark
- Medstat, 4301 Connecticut Avenue, NW, Suite 330, 20008, Washington, DC, USA.
| | | | | | | |
Collapse
|
24
|
Harris KM, Sturm R. Adverse selection and generosity of alcohol treatment benefits. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2003; 39:413-28. [PMID: 12638715 DOI: 10.5034/inquiryjrnl_39.4.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Concerns about attracting disproportionate numbers of employees with alcohol problems limit employers' willingness to offer health plans with generous alcohol treatment benefits. This paper analyzes two potential avenues of adverse selection, namely biased enrollment into plans and biased exit from plans offered by 57 employers between 1991 and 1997. We compare alcohol treatment use rates and costs of new and old enrollees between more generous and less generous plans; we also analyze disenrollment rates and enrollment duration by plan generosity for users and nonusers of alcohol treatment services. To avoid confounding benefit generosity with other plan features, in particular the use of managed care mechanisms, we compare plans that were administered in the same way by a large managed behavioral health care organization. Overall, we find no evidence of adverse selection into more generous plans. Contrary to the selection hypothesis, treatment costs of new members compared to old members are lower in firms with more generous treatment benefits than in firms with more limited benefits. Also, users of alcohol treatment services do not remain disproportionately enrolled longer in plans with generous benefits.
Collapse
Affiliation(s)
- Katherine M Harris
- Division of Clinical and Prevention Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Rockville, MD 20852, USA
| | | |
Collapse
|
25
|
Hodgkin D, Horgan CM, Garnick DW, Merrick EL. Cost sharing for substance abuse and mental health services in managed care plans. Med Care Res Rev 2003; 60:101-16. [PMID: 12674022 DOI: 10.1177/1077558702250248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent initiatives to improve private insurance coverage for substance abuse and mental health in the United States have mostly focused on equalizing coverage limits to those found in general medical care. Federal law does not address cost sharing (copayments and coinsurance), which may also deter needed care or impose significant financial burdens on enrollees. This article reports on cost sharing requirements for outpatient care in a nationally representative sample of managed care plans in 1999. Levels of cost sharing are substantial, with around 40 percent of products requiring copayments of $20 or more and another 15 percent requiring coinsurance of 50 percent. Cost sharing for outpatient substance abuse treatment is very similar to that for mental health. Compared to general medical care, at least 30 percent of products impose higher cost sharing for substance abuse and mental health treatment. Future parity initiatives should be examined for how they address differences in cost sharing as well as limits.
Collapse
|
26
|
Levy Merrick E, Garnick DW, Horgan CM, Hodgkin D. Quality measurement and accountability for substance abuse and mental health services in managed care organizations. Med Care 2002; 40:1238-48. [PMID: 12458305 DOI: 10.1097/00005650-200212000-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze managed care organizations' (MCOs') use of behavioral health quality management activities using nationally representative survey data. MATERIALS AND METHODS The primary data source is the Brandeis Survey on Alcohol, Drug Abuse, and Mental Health Services in MCOs. Using a sampling strategy designed for national estimates, we surveyed 434 MCOs in 60 market areas (response rate = 92%) regarding their commercial products' behavioral health services in 1999. Of these, 417 MCOs reported clinically oriented information for 752 products. We investigated the use of four behavioral health quality management activities: patient satisfaction surveys, clinical outcomes assessment, performance indicators, and practice guidelines. chi tests and logistic regression were used to determine effects of product type (HMO, PPO, point-of-service) and behavioral health contracting arrangement (specialty contract, comprehensive contract including general medical and behavioral health, internal provision). RESULTS Three-quarters of products used patient satisfaction surveys (70.1%), performance indicators (72.7%), and practice guidelines (73.8%) for behavioral health. Under half (48.9%) assessed clinical outcomes. HMO products were most likely, and PPOs least likely, to conduct activities. Quality activities were significantly more common among specialty-contract products. Logistic regression showed significant negative effects on quality activity use for PPO and POS products compared with HMOs. For clinical outcomes, specialty- and comprehensive-contract arrangements had significant positive effects. There were interactions between product type and contract arrangement. CONCLUSIONS Most commercial managed care products use patient satisfaction surveys, performance indicators, and practice guidelines for behavioral health, whereas clinical outcomes assessment is less common. Product type and contracting arrangements significantly affect use of these activities.
Collapse
Affiliation(s)
- Elizabeth Levy Merrick
- Schneider Institute for Health Policy, Heller School for Social Policy and Management, MS 035 Brandeis University, 415 South Street, Waltham, MA 02454-9110, USA.
| | | | | | | |
Collapse
|
27
|
Bao Y, Sauerland D, Sturm R. Changes in alcohol-related inpatient care--an international trend comparison. J Addict Dis 2001; 20:97-104. [PMID: 11318401 DOI: 10.1300/j069v20n02_08] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper studies two utilization measures of alcoholism treatment, discharge rate and average length of stay, in the United States, Australia, Sweden and Canada. The results suggest that the decline in length of stay and discharges in the past 15 years was an international phenomenon and not unique to the U.S. However, data for length of stay also suggests that the biggest decline in the United States coincided with the fastest growth of managed behavioral health care.
Collapse
Affiliation(s)
- Y Bao
- RAND, Santa Monica, CA 90401, USA.
| | | | | |
Collapse
|
28
|
McCorry F, Garnick DW, Bartlett J, Cotter F, Chalk M. Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 2000; 26:633-43. [PMID: 11098426 DOI: 10.1016/s1070-3241(00)26054-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure widespread adoption of these performance measures by health plans, private employers, public payers, and accrediting organizations. CORE PERFORMANCE MEASURES Four domains were identified, with specific measures developed for each domain: (1) prevention/education, (2) recognition, (3) treatment (including initiation of alcohol and other plan services, linkage of detoxification and AOD plan services, treatment engagement, and interventions for family members/significant others), and (4) maintenance of treatment effects. CONTINUING EFFORTS Four measures that are based on administrative information from health plans and two measures that require a consumer survey of behavioral health care are undergoing extensive pilot testing. The WCG has reached out to a broad range of stakeholders in performance measurement and managed care to acquaint them with the measures and to promote their investigation and adoption. As results of pilot testing become available, these outreach efforts will continue. CONCLUSIONS Performance measures for AOD services need to become an integral part of a comprehensive set of behavioral and physical health performance measures for managed care plans.
Collapse
Affiliation(s)
- F McCorry
- Clinical Services Unit, New York State Office of Alcoholism and Substance Abuse, Albany, New York, USA
| | | | | | | | | |
Collapse
|
29
|
Sturm R. Tracking changes in behavioral health services: how have carve-outs changed care? J Behav Health Serv Res 1999; 26:360-71. [PMID: 10565097 DOI: 10.1007/bf02287297] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This special issue of the Journal of Behavioral Health Services & Research on mental health carve-outs brings together some of the latest research on recent policy and market changes affecting behavioral health services. This introductory article provides background information about carve-outs and the managed behavioral health care industry. This article also reviews prior research in the mental health carve-out field.
Collapse
Affiliation(s)
- R Sturm
- RAND Corporation, Santa Monica, CA 90401, USA.
| |
Collapse
|