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Monitoring Treatment Outcomes and Managed Care: Promise and Challenge for AOD Field

Our treatment practices
can become ever more effective as we learn more about how much and what kind of treatment interventions offer the most long-term promise for different types of clients.

Substance Abuse and Mental Health
Services Administration
Public Health Service
U.S. Department of Health
and Human Services

Today, the substance abuse field faces a political and fiscal climate in which publicly funded services are being closely scrutinized and tightened. The American public, Congress, and State legislatures all demand proof that their public dollars are being spent effectively. The future of the substance abuse field, and our ability to provide quality care for public clients, hinges on how well we can meet this demand. For us, accountability translates into increased — and more sophisticated — monitoring of treatment outcomes. Our monitoring practices need to be assessed and refined at all levels — from State AOD agencies to regional and county agencies to treatment providers.

All of us who work in the substance abuse field know that treatment is effective. The challenge now is to identify how much treatment and what components of treatment are most successful with which clients in what phases of addiction. We need to know the minimum amount of treatment that will produce a positive benefit for different types of patients. At what point do client gains begin to taper off? The current push to shorten time in treatment and to provide less residential treatment can have destructive consequences for some publicly funded clients. We need specific outcome data to prevent reductions in treatment that come at the expense of our clients' best chances for recovery.

State substance abuse agencies and treatment providers are already weathering a dramatic change — the shift to managed care. In 1993, CSAT brought State agencies with the most experience in this arena together with other experts to explore issues affecting our clients and our traditional treatment providers functioning in managed care environments. CSAT acted as a catalyst to help States share their experiences and redefine their State agency roles.

Providing substance abuse treatment services to public clients through either Medicaid managed care or other financial arrangements has turned out to be a complicated task for State AOD agencies, with no single model fitting the varied circumstances in different States. Throughout the CSAT/State partnership, the level of technical training and expertise has been steadily rising, and our mechanisms for handling important issues have been improving. In some States, the SSA now administers the managed care networks responsible for substance abuse treatment.

Like managed care, monitoring treatment outcomes is a powerful new force affecting how we provide and fund substance abuse treatment for our public clients. The ability of States and counties to monitor, and require, certain treatment outcomes will be significant in assuring quality care for public clients, not only those treated through managed care plans but in all other State systems.

AOD treatment providers must be able to monitor their program interventions in conjunction with their clients' clinical outcomes.

CSAT will work with States to develop mechanisms to enhance and monitor treatment outcomes. Budgets are limited, funding streams and organizational structures are changing, and there are increasing demands that publicly funded treatment programs be guided and justified by measurable outcomes. Over the next few years, the treatment field needs to develop flexible mechanisms that can be adapted to a State's particular situation and the requirements of its organizational and financing arrangements.

This emphasis on measuring treatment outcomes can greatly benefit our field. Our treatment practices can become ever more effective as we learn more about how much and what kind of treatment interventions offer the most long-term promise for different types of clients. We at CSAT welcome your suggestions about how we can assist States and providers in this endeavor.

We have already undertaken these initiatives:

Two treatment outcomes planning meetings, attended by a volunteer group of State agency directors. Their recommendations provide a framework for State performance outcome measures and policies.
A contract with the Institute of Medicine, National Academy of Sciences, to convene an expert committee to assess the current state of quality assurance for managed behavioral health care networks. The committee defined key elements to be addressed in per-formance measurement and accreditation standards for these organizations and health care plans.
Contracts awarded to 14 States to pilot test different strategies for monitoring the impact of AOD treatment. These different State approaches, described in this issue, should be a rich source of practical experience. CSAT will be disseminating the findings to other States as they prepare to develop outcomes-based monitoring systems.

CSAT expects to provide technical assistance to States that request help with planning new performance and outcomes monitoring systems. Through meetings, workshops, and other methods, we will also help States and provider networks share their expertise on important issues related to outcomes monitoring, such as how to contract with managed care organizations and design State management information systems. CSAT is planning a number of technical assistance documents and workshops on managed care topics where outcome measures are an integral concern.

CSAT thanks all of you who are working so hard to improve treatment services and to ensure that our clients in the publicly funded treatment system continue to receive appropriate care and a continuum of treatment. Thanks also to those who contributed their expertise to this issue of the TIE Communiqué.

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