Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey (original) (raw)
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In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) a...
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Substance abuse treatment, prevention, and policy, 2006
Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with additio...
Dissemination Activities: a Critical new Role for Substance Abuse Treatment Organizations
The Journal of Behavioral Health Services & Research, 2014
The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBP) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities, and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations. The Affordable Care Act (ACA) emphasizes both integration of all patient care and knowledge sharing among health care providers and their stakeholders. 1 Greater coordination among treatment providers is essential for ACA's goal of narrowing and combining the paths by which health care is obtained. 2 In order to better understand organizations' propensities to engage in sharing of information such as organizational
Can the National Addiction Treatment Infrastructure Support the Public's Demand for Quality Care?
2000
As part of a larger study of the national substance abuse treatment system, the authors had an opportunity to interview the directors and key staff from a nationally representative sample of 175 drug and alcohol treatment programs. Results indicated that within the previous 16 months, 15% of facilities had closed or stopped addiction treatment and an additional 29% had been reorganized under a different agency. There was a 53% turnover among directors and a similar rate among counselors within the previous year. Less than half the programs had a full-time physician or nurse, and very few programs had a social worker or psychologist. The predominant form of treatment was abstinence-oriented group counseling. The intake process typically required 2 to 4 hours to collect data required by managed care and city, state, and federal agencies. Very few programs had computers for clinical operations or decision support. These findings are disturbing and call into question the ability of the national treatment system to meet the complex demands of both the patients that enter this system and the agencies that refer to it. D
Journal of Substance Abuse Treatment, 1999
Primary care and mental health services improve drug abuse treatment clients' health and treatment outcomes. To examine the association between clients' access to these services and the characteristics of drug treatment organizations, we analyze data from a national survey of the unit directors and clinical supervisors of 618 outpatient drug abuse treatment programs in 1995 (88% response rate). In multivariate models controlling for client characteristics and urban location, public units, units with more human resources, and methadone programs delivered more primary care services. Public units, Joint Commission on Accreditation of Health Care Organizations-accredited units, nonmethadone units, and units with more staff psychiatrists or psychologists delivered more mental health services. We conclude that organizational factors may influence drug abuse treatment clients' access to primary care and mental health services. Changes in the treatment system that weaken or eliminate public programs, overburden staff, de-emphasize quality standards or lessen methadone availability may erode recovering clients' tenuous access to these services.
Managed care and technical efficiency in outpatient substance abuse treatment units
The Journal of Behavioral Health Services & Research, 1998
This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment ( OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.