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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Background of the NIDA Center

This is the 3rd iteration of the Brandeis/Harvard NIDA Center, which began in September 1995, with a 5-year renewal starting September 2004.

1st Center (1995-2003) The Center was originally 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 1st 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.

2nd Center (2005-2013) built on the understanding that 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 noted, “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 2nd iteration of the Center addressed the following questions:  What specific elements of organization, management, financing and payment make a difference in effective drug abuse service delivery? How can incentives within these four areas be used to encourage or support the provision of quality drug abuse treatment services?

On a conceptual level, this theme was 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? We moved 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.

A major focus of our research was to learn how to align the organizational and financial incentives inherent in managed care to improve the quality of drug abuse treatment services.

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