The Theme
The theme of the Center in its second generation is:
A conceptual view of the questions the Center's projects intend to answer within each area is provided by this visual matrix.
On a conceptual level, this theme is similar to research in the treatment effectiveness area which asks the question: what are the treatment elements and support services that result in effective treatment (Leshner, 1999; McLellan et al., 1997). We will move similarly from the global concept of managed care to examine what specific elements of different managed care arrangements are the ingredients that contribute to effective service delivery.
The Center's Focus: Managed Care Strategies
The ubiquitous use of managed care strategies within the current health care system has not uniformly led to the delivery of effective care. The seminal Institute of Medicine study (2001) on the quality of American healthcare notes,“quality problems are everywhere … between the health care we have and the health care we could have lies not just a gap, but a chasm.” (p.1).
It further notes, "what is perhaps most disturbing is the absence of real progress toward restructuring health care systems to address both quality and cost concerns, or toward applying advances in information technology to improve administrative and clinical processes." (p. 3)
The Center examines specific strategies used in managed care and drug abuse treatment that fall into four areas:
- Organization
Referring to macro type elements, such as carve-out arrangements, provider mix, and product type - Management
Referring to more micro techniques used to control service provision, such as provider profiling and performance standards - Financing
Including macro issues, such as coverage for specific services and parity with medical care - Payment
Referring to more micro level issues, such as type of provider reimbursement and generosity of reimbursement
Moreover, we examine how incentives within these four areas can be used to improve provider, organizational and system performance. Performance-based incentives are widely discussed and are being implemented in the provision of some types of care, including behavioral health (Frank and McGuire 2001). However, too little attention has been paid to the careful analysis and alignment of payment incentives with quality improvement (IOM 2001, Robinson 2001). A major focus of our research, then, is to learn how to align the organizational and financial incentives inherent in managed care to improve the quality of drug abuse treatment services.