Performance contracting to engage detoxification-only patients into continued rehabilitation

Haley, Sean J.; Dugosh, Karen L.; Lynch, Kevin G.

doi:10.1016/j.jsat.2010.09.001

Cited by 24 publications

(25 citation statements)

References 40 publications

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“…In other countries, residential treatment has tended to be reserved for individuals who have tried but have been unsuccessful in the community, or whose problems are too complex or too severe to be safely managed in the community (Gossop, 1995). Multiple recent admissions to detox suggest a high present risk of relapse, suggesting the difficulties of linking detoxification to long-term treatment (Haley, Dugosh, & Lynch, 2011; Mattick & Hall, 1996). The principle of ‘stepped care’, which refers to the strategy of offering the least intensive level of care that meets treatment objectives (Mee-Lee & Shulman, 2009; National Collaborating Centre for Mental Health, 2008) has had only modest empirical support, and accepted criteria for such a systematic matching are lacking (Ghodse, 2010).…”

Section: 0 Discussionmentioning

confidence: 99%

Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification

Stein

Anderson

Bailey

2015

Journal of Substance Abuse Treatment

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Without aftercare treatment, the period following discharge from short-term inpatient detoxification for opioid dependence presents a high risk of relapse. Yet the role of patient preference in treatment selection is rarely discussed in the substance-abuse literature. We surveyed 485 persons initiating inpatient opioid detoxification who were predominantly male (71.3%) and had detoxed in the past (73.2%). When asked to choose the one treatment that would work best for them after discharge, 43% of participants selected medication assisted treatment (MAT), 29% preferred residential, 12% selected drug-free counseling, 12% NA/AA meetings only, and 4% preferred no additional treatment. Residential treatment preference was significantly associated with homelessness, having been in a detox program within the past year, and having pending legal problems, indicating that there is a distinct profile of detox patients who prefer residential treatment despite its limited availability. Detox program staff should work with patients to understand reasons for treatment preferences to optimize aftercare services.

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Section: 0 Discussionmentioning

confidence: 99%

Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification

Stein

Anderson

Bailey

2015

Journal of Substance Abuse Treatment

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“…All 15 studies were conducted in the United States. Four (1-4) examined P4P programs implemented nationally, and 11 examined programs implemented in a state or county: Maine (five studies [5][6][7][8][9]); Delaware (three [10][11][12]); Massachusetts (one [13]); Baltimore, Maryland (one [14]); and King County, Washington (one [15]). Outcomes included organizational, clinician, and patient factors, such as client retention, wait time, occupancy, length of stay, target threshold of treatment provided, and program completion ( Table 1).…”

Section: Review Of P4p In Behavioral Health Carementioning

confidence: 99%

“…Eight studies (4-9,11,12) also evaluated the effects of P4P on gaming (such as patient selection and dumping) and other unintended consequences. Four studies found evidence for patient characteristic changes (11,12), information reporting changes (9), and reallocation of time to provision of fewer services (4).…”

Section: Review Of P4p In Behavioral Health Carementioning

confidence: 99%

Can We Pay for Performance in Behavioral Health Care?

Stewart¹,

Lareef²,

Hadley³

et al. 2017

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Pay for performance (P4P) has become a popular strategy to reward quality and cost-efficiency in behavioral health care and other health care disciplines. This column presents the results of a literature review of P4P in behavioral health care. Fifteen empirical studies evaluating the outcomes of behavioral health services provided in a P4P system were identified. The limited data suggest that P4P can achieve its desired effect. More research is needed on outcomes, performance, and unintended consequences.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Garnick

Horgan

Acevedo

et al. 2017

Journal of Substance Abuse Treatment

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Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies’ own baselines. Weekly feedback was e-mailed to agencies in the alert or alert plus incentives arms. Difference-in difference regressions controlling for client and agency characteristics showed that none of the interventions significantly affected client engagement after outpatient admissions, overall or for sub-groups based on race/ethnicity, age, rural residence, or agency baseline performance. Treatment agencies offered insights related to several themes: delivery system context (e.g., agency time and resources needed during transition to a managed behavioral healthcare system), implementation (e.g., data lag), agency issues (e.g., staff turnover), and client factors (e.g., motivation). Interventions took place during a time of Medicaid expansion and planning for statewide integration of mental health and substance use disorder treatment into a managed care model, which may have resulted in agencies not responding to the interventions. Moreover, incentives and alerts at the agency-level may not be effective when factors are at play beyond the agency’s control.

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Performance contracting to engage detoxification-only patients into continued rehabilitation

Cited by 24 publications

References 40 publications

Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification

Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification

Can We Pay for Performance in Behavioral Health Care?

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

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