Substance Abuse Treatment Pathways for Employee Groups

Facilitating substance abuse treatment access and engagement is critical because drug and alcohol disorders are frequently not addressed despite availability of effective treatment. In the private sector, there are several potential pathways into specialty treatment, including managed behavioral health carve-out plans and employee assistance programs (EAPs) that can be provided by different organizations or by the same managed behavioral health care organization. The study is investigating the roles and interrelationship between these employer-sponsored programs as well as other resources for substance abuse problems regarding treatment access and engagement.

In this collaborative project with MHN, a national managed behavioral health care organization with enrollment of about 10 million members, the Brandeis/Harvard research team is making use of diverse and complementary data sources to span 1999-2008, including administrative data and an enrollee survey, to address the following research goals:

• Describe substance abuse access, utilization, costs, and performance indicators in EAP and managed behavioral health products
• Compare findings for integrated (EAP/managed behavioral health) versus stand-alone component products
• Investigate other influences on utilization from employer, plan, provider and individual domains (e.g. workplace policies, state parity laws, utilization management procedures, client experience of care, employee beliefs about confidentiality, pressure to enter treatment)

This study will enable the development of a multifaceted model of substance abuse treatment access and engagement that includes behavioral health product type/structure as well as factors from other key domains. The results will be of interest to employers, insurers, policymakers and others concerned with improving access to substance abuse treatment in privately insured populations.

to top

Profiling and Incentives in Behavioral Health Care

Although managed behavioral health care has achieved impressive cost reductions in the public sector, its relationship to quality has been a continuing concern, particularly when disadvantaged groups are affected. This research explores innovative ways to improve the quality of care for low-income general assistance clients who receive substance abuse treatment under the state of Connecticut’s managed behavioral health care system.

Using a design that randomizes treatment agencies to conditions, this study is comparing three approaches to improving the quality of substance abuse treatment among publicly-funded treatment for substance abuse in the state of Connecticut. So far, 54 treatment facilities providing detox or residential treatment have been randomized to one of two conditions: (1) basic profiling, or (2) basic plus enhanced profiling. Collectively, these agencies serve approximately 25,000 Connecticut state-administered general assistance (SAGA) clients who are covered annually under Connecticut's general assistance behavioral health care program (GAPBH).

Basic profiling consists of the state’s Department of Mental Health and Addiction Services (DMHAS) mailing a one-page basic profile to the chief executive of each treatment agency, for each level of care it provides. The basic profile, which covers treatment exits (discharges) from treatment in the last 3 or 6 months, shows the number of exits during the recall period and the percentage of these clients who connected to care at a lower level of intensity (a favorable outcome) or were readmitted to a higher level of care (an unfavorable outcome). Basic profiles had been distributed from October 2001 through April 2004, and, after a hiatus, were resumed in October 2005.

Agencies randomized to the enhanced group receive coaching from a team of DMHAS regional managers and their staff consisting of additional information and tools, and encouragement and training in quality improvement techniques and best practices. This coaching is focused on key profile measures and generally being provided through in-person meetings twice per year.

In 2007, the project plans to randomize half of the agencies in the enhanced profiling group into an incentives group that will receive a package of financial and non-financial incentives if they perform in the top quartile of their level of care. These agencies will be rewarded with administrative, referral, recognition, and financial incentives during year two and year three. Whether or not these agencies are randomized into the incentives group, these agencies will continue to receive advanced profiling.

Site visits and provider surveys will be used to obtain qualitative information about the awareness of the treatment arms. Next, we will evaluate the impact of profiling through administrative data to see whether there are changes in client transitions and costs of subsequent care. We have been advising DMHAS regarding the development of a case mix index to adjust for differences in the patient population of different agencies. The project will also conduct developmental work evaluating performance in agencies with few discharges during the reference period. In this case, information from the agencies’ past performance, characteristics of the agency, and performance of similar agencies may be incorporated into the analysis.

to top

Substance Abuse Treatment and Work Programs

The interrelations among substance abuse, treatment and work are complex and have increasing policy importance. At the same time, public policy related to substance abuse disorders, their treatment, and income support programs and work is poorly conceived and controversial. For some purposes (public and most private health insurance) substance abuse is regarded as an illness worthy of collective financial support. For other purposes (federal disability programs) substance abuse fails to qualify as a reason for support. Our research explores the design of payment incentives for programs that seek to offer services to support labor market entry for income support program participants with substance abuse disorders. We do so with theoretical and empirical methods, and apply these results in policy simulations.

We intend to develop a novel conceptual framework drawing from the field of health care payment systems, where methodologies for deriving the characteristics of  “optimal payment systems” is highly developed. Many analogies can be drawn between health payment systems and payment systems for work-related services that give us a starting point for this research. Using methods from labor economics, we are conducting empirical work to quantify important relationships using several data sets. Our primary interest is in the factors associated with return to successful employment. We are studying the characteristics of beneficiaries, how these relate to return to work, and how this favorable outcome is related to program organization and financing. We will apply the findings from our theoretical and empirical analysis to state and federal policies related to substance abuse and employment.

Our specific aims are as follows:

• To set forth an economic framework that integrates beneficiary incentives and service provider incentives for successful return to work by people suffering from substance abuse disorders.
• To conduct a series of empirical analyses to estimate key parameters to design a payment system to encourage successful return to work by people with substance abuse disorders. In particular we will seek to develop evidence on the use of performance-based evaluations for providers and program design incentives for potential workers with substance abuse disorders.
• To build a policy simulation model capable of being applied to a range of policies that affect the return to work of people with substance abuse disorders that participate in income support programs.

to top