Access to Substance Abuse Treatment Services Under the Oregon Health Plan

Deck, Dennis; McFarland, Bentson H.; Titus, Jessica; Laws, Katherine E.; Gabriel, Roy M.

doi:10.1001/jama.284.16.2093

Cited by 44 publications

(27 citation statements)

References 18 publications

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“…underestimation) about service delivery over the 1990s. This study thus appears consistent with other research that could not detect unredeemably negative trends in access to and quality of behavioral health care over the 1990s (Beinecke, Shepard, Tetreault, Hodgkin, & Marckres, 2001;Deck, McFarland, Titus, Laws, & Gabriel, 2000).…”

Section: Discussionsupporting

confidence: 91%

Trends in comprehensive service availability in outpatient drug abuse treatment

Friedmann

Lemon

Durkin

et al. 2003

Journal of Substance Abuse Treatment

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Comprehensive medical and psychosocial services are essential to quality addiction treatment, but their availability declined in the 1980s. To determine whether this downward trend in the availability of comprehensive services continued in the 1990s, we analyzed data from a national panel study of outpatient substance abuse treatment units in 1990, 1995, and 2000. Response rates were greater than 85%. Regarding the availability of comprehensive services, including physical examinations, routine medical care, mental health services, financial counseling and employment counseling, administrators reported whether any substance abuse treatment client received the service in the past year. With the exception of physical examinations, whose reported availability increased from 1990 to 1995, and financial counseling, whose reported availability decreased during the same time, the reported availability of comprehensive services changed little during the 1990s. These findings highlight the continuing need to monitor access to comprehensive services and other quality markers in addiction treatment over time.

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Section: Discussionsupporting

confidence: 91%

Trends in comprehensive service availability in outpatient drug abuse treatment

Friedmann

Lemon

Durkin

et al. 2003

Journal of Substance Abuse Treatment

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“…These estimates of readmission rate increases should be compared with the 30% rise in access to substance abuse treatment found in previous studies of Oregon's Medicaid population. 13 The implication here is that increased access may explain at least some of the apparent rise in readmission rates following the conversion to managed care. While readmission rates rose in several health plans from before to after managed care, 1 not-for-profit program in Oregon had a notable decrease.…”

Section: Discussionmentioning

confidence: 92%

“…Detailed descriptions of the health plans have been provided elsewhere. 13 Briefly, this project focused on the 6 prepaid health plans (ranging in size from roughly 8000 to about 50,000 Medicaid clients) that enrolled the majority of Medicaid clients. One plan was for-profit and the others were not-for-profit.…”

Section: Oregon Health Planmentioning

confidence: 99%

Outcomes for medicaid clients with substance abuse problems before and after managed care

McFarland

Deck

McCamant

et al. 2005

The Journal of Behavioral Health Services & Research

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Medicaid conversion from fee for service to managed care raised numerous questions about outcomes for substance abuse treatment clients. For example, managed care criticisms include concerns that clients will be undertreated (with too short and/or insufficiently intense services). Also of interest are potential variations in outcome for clients served by organizations with assorted financial arrangements such as for-profit status versus not-for-profit status. In addition, little information is available about the impact of state Medicaid managed care policies (including client eligibility) on treatment outcomes. Subjects of this project were Medicaid clients aged 18-64 years enrolled in the Oregon Health Plan during 1994 (before substance abuse treatment managed care, N = 1751) or 1996-1997 (after managed care, N = 14,813), who were admitted to outpatient non-methadone chemical dependency treatment services. Outcome measures were retention in treatment for 90 days or more, completion of a treatment program, abstinence at discharge, and readmission to treatment. With the exception of readmission, there were no notable differences in outcomes between the fee for service era clients versus those in capitated chemical dependency treatment. There were at most minor differences among various managed care systems (such as for-profit vs not-for-profit). However, duration of Medicaid eligibility was a powerful predictor of positive outcomes. Medicaid managed care does not appear to have had an adverse impact on outcomes for clients with substance abuse problems. On the other hand, state policies influencing Medicaid enrollment may have substantial impact on chemical dependency treatment outcomes.

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“…4°,41 A Section 1115 waiver, obtained from the Centers for Medicaid & Medicare Services, allowed Oregon to expand Medicaid coverage to all adults and their dependents who fall below the federal poverty level. 37,42 The neighboring state of Washington is geographically and demographically similar, but substance abuse services are state administered and providers are reimbursed for treatment services to Medicaid recipients on a fee-for-service basis. Although Washington provides full coverage for the MMT, matching funds are scarce and legislation limited the size and location of methadone clinics during the study period.…”

Section: Study Sitesmentioning

confidence: 99%

Retention in publicly funded methadone maintenance treatment in two western states

Deck

Carlson

2005

The Journal of Behavioral Health Services & Research

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This study examined individual and system characteristics associated with retention in methadone maintenance treatment among Medicaid-eligible adults in treatment for opiate use in Oregon and Washington. Logistic regression was used to examine the contributions of predisposing, need, and enabling characteristics on 365 day retention in methadone maintenance treatment. Older patients, patients with a history of methadone maintenance treatment, and persons with stable Medicaid eligibility had higher rates of retention than did patients with disabilities, polysubstance users, and those with an arrest record. In Oregon, which delivers methadone maintenance treatment through managed care, retention rose sharply from 28% to 51% between 1994 and 1998 and then leveled off. During the same time period, retention in Washington State grew from 28% to 34%. The higher rates of retention in Oregon, in part, can be explained by differences in service delivery influenced by financing. Faced with long waiting lists, Washington providers were more than twice as likely to administratively discharge patients for rule violations as their Oregon counterparts. Given the importance of retention, policies and practices that influence retention should be carefully considered. Because Medicaid eligibility has a dramatic impact on retention, policies that help extend eligibility or stabilize eligibility among individuals actively engaged in treatment should be carefully considered.

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Access to Substance Abuse Treatment Services Under the Oregon Health Plan

Abstract: According to our analyses, Medicaid-eligible persons in Oregon observed an increase in access to substance abuse treatment after a shift to managed care. JAMA. 2000;284:2093-2099.

Cited by 44 publications

References 18 publications

Trends in comprehensive service availability in outpatient drug abuse treatment

Trends in comprehensive service availability in outpatient drug abuse treatment

Outcomes for medicaid clients with substance abuse problems before and after managed care

Retention in publicly funded methadone maintenance treatment in two western states

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