The Brandeis/Harvard Center to Improve System Performance of Substance Use Disorder Treatment

The Heller School for Social Policy and Management at Brandeis University

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Conceptual Framework

The work of the Center builds on a conceptual framework that maps out economic and organizational influences on the accessibility, quality and cost of treatment for substance use disorders.

We use a variant of a three-actor model which is often used to understand health systems (e.g., Horgan & Merrick, 2001). It distinguishes three key actors in health care: patient, payer (e.g., insurer or state SUD agency), and provider. Given our Center’s focus, we have modified the framework to break the ‘provider’ box into two components: the provider organization (e.g., treatment program, ACO) and the individual clinician.

In an era of new health care system delivery and financing approaches, including risk-based ACOs and value-based purchasing strategies, provider organizations are increasingly the locus of accountability. Further, how provider organizations interact with both payers and clinicians to implement new financing and delivery models is central to success in improving system performance.

The Center focuses more on the delivery system, specifically on the relationships between payers, provider organizations and clinicians (arrows A and B). We also highlight the outcomes of greatest interest to our Center: access, quality and costs of treatment for SUDs.

chart of conceptual framework

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