The intent of this research is to contribute to our knowledge about the effective organization, delivery, and financing of alcoholism services. To do this, the study will examine the impact of the most innovative managed care program implemented to date for a Medicaid population. The lack of sufficient information on the use and costs of alcohol treatment services under existing insurance programs has been a substantial barrier to assessing the impact of national health reform proposals on people with alcohol disorders. Further, it is time to explore how the quality of care for alcohol disorders can be monitored and assessed under managed care. The proposed study considers how the alcoholism treatment utilization and cost patterns for a high-risk population differ under a traditionally- financed program and an innovative managed care program and considers as well other financing changes (fee levels, cost-based versus prospective payment, provider capitation). The study will link these treatment patterns to exploratory indices of the quality of care. The managed care program, implemented by Massachusetts Medicaid, includes both utilization review and selective provider contracting and it expanded the types of alcoholism providers to include hospital diversionary services (alternative detoxification settings, new residential care and crisis stabilization). The major objective of this study is to understand how the utilization and cost of services is associated with factors related to alcohol treatment organization, delivery, and financing under managed care. To accomplish the major objective, the proposed study will address the following specific aims: 1. Describe the alcohol treatment patterns (the utilization of treatment and cost of treatment services) for a population with alcohol disorders using longitudinal data constructed from Medicaid claims, and examine the impact of managed care on treatment costs. 2. Examine the factors associated with readmissions to intensive alcohol treatment settings (inpatient hospital care and residential settings) and examine the impact of managed care features on readmissions. 3. Explore the feasibility of constructing quality-of-care indices in a managed care environment using existing secondary data collected on insurance claim records for alcohol treatment and from case management records maintained by a utilization review entity. Analyses will draw on two data sets that will be obtained from the Massachusetts Division of Medical Assistance: (a) Medicaid insurance claims records for ADM care for fiscal years 1990 through 1995; and (b) Case management records for clients receiving prior authorization for inpatient and residential services for fiscal years 1993 through 1995.
| Shepard, D S; Larson, M J; Hoffmann, N G (1999) Cost-effectiveness of substance abuse services. Implications for public policy. Psychiatr Clin North Am 22:385-400, x |
| Larson, M J; Samet, J H; McCarty, D (1997) Managed care of substance abuse disorders. Implications for generalist physicians. Med Clin North Am 81:1053-69 |
