The Center's Background

The Brandeis/Harvard Center began in September 1995, with a 5-year renewal starting September 2004. The Center was originially established during a time in which drug abuse treatment in both the public and private sectors was increasingly being delivered in a managed care environment. Thus, the organizing theme of the prior Center became the assessment of "managed care on drug abuse treatment availability, content, duration, and utilization, as well as on treatment financing and organization." This theme built on the long history that both Brandeis and Harvard researchers had in studying the organization, financing and delivery of drug, alcohol and mental health services, and also in examining the health care delivery system more broadly in terms of the impact of managed care.

This broad focus on managed care and drug abuse treatment was appropriate in 1995 because the US health care system was in the early stages of rapid and fundamental change in how care was organized and financed. These changes, loosely labeled as managed care, were marked by innovation in terms of contractual arrangements between payers (both public and private) and providers. In the drug abuse area, services frequently were combined with mental health and alcohol treatment and referred to as managed behavioral healthcare, which was sometimes carved out from the rest of health care.

Although managed care was expanding rapidly, little was known about what it actually involved and more importantly what might be its impact. The past work of this NIDA Center might be thought of as conducting "first generation" studies that sought to describe the "black box" of managed care, to examine its growth, and to compare its impact on cost and utilization to more traditional arrangements, such as fee-for- service. Because managed care covers such a large part of the U.S. population and because it is changing, it is essential that we move to the second generation of research to understand which specific elements of managed care make a difference in the effective delivery of substance abuse services.