Performance contracting and quality improvement in outpatient treatment: Effects on waiting time and length of stay

Abstract

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes.

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

“…E. Stewart, Lareef, Hadley, & Mandell, 2017). Studies of implementation of incentive payments focused on substance use disorders have been focused on the public sector (Brucker & Stewart, 2011; Commons, McGuire, & Riordan, 1997; Lu, Albert Ma, & Yuan, 2003; Lu & Ma, 2006; Shen, 2003; M. T. Stewart, Horgan, Garnick, Ritter, & McLellan, 2013).…”

“…T. Stewart, Horgan, Garnick, Ritter, & McLellan, 2013). In 2001, Delaware implemented performance based contracting (PBC) for outpatient treatment agencies based on performance targets established in contracts with the state agency (Haley, Dugosh, & Lynch, 2011; McLellan, Kemp, Brooks, & Carise, 2008; M. T. Stewart et al, 2013), showing increased outpatient utilization (McLellan et al, 2008) as well as shorter waiting time for treatment, improved engagement and longer length of stay (M.…”

Private Health Plans’ Contracts with Managed Behavioral Healthcare Organizations

“…Thus, it will be key to ascertain health plans’ approaches to contract enforcement and whether more stringent contract terms are associated with measures of the quality of behavioral health services such as substance abuse performance measures used by NCQA, clinical outcomes, or patient-reported perceptions of the quality of behavioral healthcare. If the current trend towards value-based purchasing in the general medical sector 23,24 and some state-funded systems 9,25 becomes more widely adopted for behavioral health in the private sector, health plans and MBHOs will stand to gain financially from paying more attention to quality. One result will likely be a greater focus on quality in contracts between health plans and MBHOs.…”

“…For example, health plans need to be aware that techniques used to authorize treatment entry and continuation of care may lead to decreased utilization of specialty services. 4,9 How well MBHOs conduct administrative functions such as claims processing could potentially influence specialty providers’ decisions to participate in MBHOs’ provider networks, which in turn could have direct implications for patients’ access to specialty services.…”

Enhancing Transitions from Addiction Treatment to Primary Care

“…47 Also conceptually appealing, although untested with regard to AT to primary care transitions, is the use of incentives for providers to manage patients to make the transition successfully. 48 Such performance-based contracting has been shown to be associated with improvements in length of treatment stay and wait times for treatment, 49 although not consistently. 50…”