Improving public addiction treatment through performance contracting: The Delaware experiment

Abstract

In fiscal 2002, Delaware replaced traditional cost-reimbursement contracts with performance-based contracts for all outpatient addiction treatment programs. Incentives included 90% capacity utilization and active patient participation in treatment. One of the programs failed to meet requirements. Strategies adopted by successful programs included extended hours of operation, facility enhancements, salary incentives for counselors, and two evidence-based therapies (MI and CBT). Average capacity utilization from 2001 to 2006 went from 54% to 95%; and the average proportion of patients' meeting participation requirements went from 53% to 70%--with no notable changes in the patient population. We conclude that properly designed, program-based contract incentives are feasible to apply, welcomed by programs and may help set the financial conditions necessary to implement other evidence-based clinical efforts; toward the overall goal of improving addiction treatment.

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

“…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.…”

A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment

“…outpatient vs inpatient); to the treatment processes (e.g. retention in treatment); to the quantity and quality of treatment; and to treatment outcomes (Fuller, Rieckmann, McCarty, et al, 2005;Ghose, 2008;Heinrich & Fournier, 2005;Knudsen & Roman, 2012;Mason, Sutton, Whittaker, et al, 2015;McLellan, Kemp, Brooks, et al, 2008;Stein, Reardon, & Sturm, 1999;Soman, Brindis, & Dunn-Malhotra, 1996;Sosin, 2005). Thus purchasing arrangements can have important impacts on service delivery and health outcomes.…”

Performance contracting to engage detoxification-only patients into continued rehabilitation

“…In 2007, the Delaware Department of Substance Abuse and Mental Health (DSAMH) implemented its first performance contract for outpatient services and focused upon full occupancy of outpatient treatment slots and active attendance during treatment (McLellan, Kemp, Brooks, & Carise, 2008). As a purchasing mechanism, performance contracting was associated with rapid and sustained increases in both of the performance targets.…”

“…In FY 2008, building upon their prior successful contract experience (McLellan et al, 2005(McLellan et al, , 2008, DSAMH initiated a performance-contract with the goal of increasing rates of transition from detoxification to other forms of continuing care and coupled it with case management for frequent detoxification users (defined as having three or more detoxification admissions in the same patient year) to achieve two core goals:…”