A performance measure for continuity of care after detoxification: Relationship with outcomes

Lee, Margaret T.; Horgan, Constance M.; Garnick, Deborah W.; Acevedo, Andrea; Panas, Lee; Ritter, Grant; Dunigan, Robert; Babakhanlou‐Chase, Hermik; Bidorini, Alfred; Campbell, Kevin; Haberlin, Karin; Huber, Alice; Lambert-Wacey, Dawn; Leeper, Tracy; Reynolds, Mark

doi:10.1016/j.jsat.2014.04.002

Cited by 36 publications

(25 citation statements)

References 31 publications

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“…The use of illicit and misuse of licit substances remains a substantial population health concern in rural America. [1][2][3] Continuity into follow-up treatment for a substance use disorder (SUD) within the 1 or 2 weeks after discharge from detoxification [4][5][6][7] or residential treatment 8,9 is associated with improved outcomes, yet the majority of clients do not even begin this continuing treatment. [10][11][12] Access to continuing care is especially limited in rural and non metropolitan areas, [13][14][15][16][17][18] an issue of particular importance since failure to receive adequate treatment can contribute to the burden of SUDs in rural America.…”

Section: Discussionmentioning

confidence: 99%

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Garnick

Horgan

Acevedo

et al. 2019

The Journal of Rural Health

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Purpose Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow‐up treatment and whether financial incentives and weekly alerts have a modifying effect. Methods For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control. Travel time was used as both a main effect and interacted with other variables to explore its modifying impact on continuity of care in conjunction with incentives or alerts. Continuity was defined as follow‐up care occurring within 14 days of discharge from detoxification or residential treatment programs. Travel time was estimated as driving time from clients’ home ZIP Code to treatment agency ZIP Code. Findings Travel times to the original treatment agency were in some cases significant with longer travel times predicting lower likelihood of continuity. For detoxification clients, those with longer travel times (over 91 minutes from their residence) are more likely to have timely continuity. Conversely, residential clients with travel times of more than 1 hour are less likely to have timely continuity. Interventions such as alerts or incentives for performance had some mitigating effects on these results. Travel times to the closest agency for potential further treatment were not significant. Conclusions Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.

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Section: Discussionmentioning

confidence: 99%

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Garnick

Horgan

Acevedo

et al. 2019

The Journal of Rural Health

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“…21 Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, place of service, and primary substance use or mental disorder diagnosis were used to identify residential behavioral health treatment (RES), excluding detoxification; partial hospital or intensive outpatient program (IOP); outpatient behavioral health services (OP); and MAT, defined as a prescription fill of buprenorphine, disulfiram, acamprosate, or naltrexone or a HCPCS service code for methadone, buprenorphine, or naltrexone.…”

Section: Methodsmentioning

confidence: 99%

“…12 Receiving addiction treatment soon after discharge is associated with reduced detoxification readmission, 20,21 with stronger findings for residential than outpatient. 21 …”

Section: Introductionmentioning

confidence: 99%

Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter?

Reif

Acevedo

Garnick

et al. 2017

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Objective Individuals with substance use disorders are at high risk for hospital readmission. This study examined whether targeted follow-up services received within 14 days postdischarge from an inpatient hospital stay or residential detoxification reduced readmissions within 90 days, among Medicaid beneficiaries who had an index substance use disorder diagnosis. Methods Claims data were analyzed for Medicaid beneficiaries aged 18–64 years with a substance use disorder diagnosis coded as part of an inpatient hospital stay or residential detoxification in 2008 (N=30,439). Follow-up behavioral health services included residential, intensive outpatient, or outpatient treatment, and/or medication-assisted treatment (MAT). Analyses included 10 states or fewer based on a minimum number of index admissions and prevalence of follow-up services or MAT. Survival analyses with time-varying independent variables were used to test the association of follow-up services and MAT with behavioral health readmissions. Results Two-thirds of individuals with an index admission had no follow-up services within 14 days. Behavioral health admissions 90 days postdischarge were present for 29% of individuals with an index admission. Survival analyses showed that MAT and residential treatment were associated with reduced risk of behavioral health admission in the 90 days postdischarge. However, outpatient was associated with increased risk of readmission, as was intensive outpatient in one model. Conclusions Provision of MAT or residential treatment for substance use disorders after an inpatient or detoxification stay may help prevent future readmissions. Medicaid programs should be encouraged to reduce barriers to MAT and residential treatment to prevent future behavioral health admissions.

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“…Over a fifth of annual admissions to SUD treatment are for detox (Center for Behavioral Health Statistics and Quality, 2014). Studies have shown that continuity of care after detox is associated with better outcomes, including reduced detox readmission (Lee et al, 2014; Mark, Vandivort-Warren, & Montejano, 2006). However, many receiving detox services do not receive follow-up treatment.…”

Section: Introductionmentioning

confidence: 99%

Design and impact of bundled payment for detox and follow-up care

Quinn

Hodgkin

Perloff

et al. 2017

Journal of Substance Abuse Treatment

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Introduction Recent payment reforms promote movement from fee-for-service to alternative payment models that shift financial risk from payers to providers, incentivizing providers to manage patients’ utilization. Bundled payment, an episode-based fixed payment that includes the prices of a group of services that would typically treat an episode of care, is expanding in the United States, including mandatory models in Medicare. Bundled payment has not been developed specifically for substance use disorder (SUD) treatment. Yet, bundled payment has been recommended as a way to pay for comprehensive SUD treatment and has the potential to improve treatment engagement after detox, which could reduce detox readmissions, improve health outcomes, and reduce medical care costs. However, if moving to bundled payment creates large losses for some providers, it may not be sustainable. The objective of this study was to design a bundled payment for detox and follow-up care and to estimate its impact on provider revenues. Methods Massachusetts Medicaid beneficiaries’ behavioral health, medical, and pharmacy claims from July 2010–April 2013 were used to build and test a detox bundled payment for continuously enrolled adults (N=5,521). A risk adjustment model was developed using general linear modeling to predict beneficiaries’ episode costs. The projected payments to each provider from the risk adjustment analysis were compared to the observed baseline costs to determine the potential impact of a detox bundled payment reform on organizational revenues. This was modeled in two ways: first assuming no change in behavior and then assuming a supply-side cost sharing behavioral response of a 10% reduction in detox services and an increase of one individual counseling and one group counseling session. Results The mean total 90-day detox episode cost was $3,743. Nearly 70 percent of the total mean cost consists of the index detox, psychiatric inpatient care, and short-term residential care. Risk mitigation, including risk adjustment, substantially reduced the variation of the mean episode cost. There are opportunities for organizations to gain revenue under this bundled payment design, but many providers will lose money under a bundled payment designed using historic payment and costs. Conclusions Designing a bundled payment for detox and follow-up care is feasible, but low case volume and the adequacy of the payment are concerns. Thus, a detox episode-based payment will likely be more challenging for smaller, independent SUD treatment providers. These providers are experiencing many changes as financing shifts away from block grant funding toward Medicaid funding. A detox bundled payment in practice would need to consider different risk mitigation strategies, pooling providers, and an increased reimbursement rate, but could incentivize care coordination, which is important to reducing detox readmissions and engaging patients in care.

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A performance measure for continuity of care after detoxification: Relationship with outcomes

Cited by 36 publications

References 31 publications

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Reducing Behavioral Health Inpatient Readmissions for People With Substance Use Disorders: Do Follow-Up Services Matter?

Design and impact of bundled payment for detox and follow-up care

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