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Performance-Based Contracting Within a State Substance Abuse Treatment System: A Preliminary Exploration of Differences in Client Access and Client Outcomes

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Abstract

To explore whether the implementation of performance-based contracting (PBC) within the State of Maine’s substance abuse treatment system resulted in improved performance, one descriptive and two empirical analyses were conducted. The first analysis examined utilization and payment structure. The second study was designed to examine whether timeliness of access to outpatient (OP) and intensive outpatient (IOP) substance abuse assessments and treatment, measures that only became available after the implementation of PBC, differed between PBC and non-PBC agencies in the year following implementation of PBC. Using treatment admission records from the state treatment data system (N = 9,128), logistic regression models run using generalized equation estimation techniques found no significant difference between PBC agencies and other agencies on timeliness of access to assessments or treatment, for both OP and IOP services. The third analysis, conducted using discharge data from the years prior to and after the implementation of performance-based contracting (N = 6,740) for those agencies that became a part of the performance-based contracting system, was designed to assess differences in level of participation, retention, and completion of treatment. Regression models suggest that performance on OP client engagement and retention measures was significantly poorer the year after the implementation of PBC, but that temporal rather than a PBC effects were more significant. No differences were found between years for IOP level of participation or completion of treatment measures.

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Notes

  1. Although length of stay and completion of treatment measures were both available as possible outcome measures for OP and IOP services, management decided to partner length of stay with number of sessions for OP retention measures and to partner completion of treatment with number of days in treatment for IOP retention measures. As length of stay in OP programs was typically brief, providers had communicated to the state agency that they felt length of stay would be a better outcome indicator for a 4 to 6 weeks’ OP program. In addition, OP had some clear national indicators that were appropriate to use as benchmarks whereas IOP did not.

  2. Linear regression models were also run. PBC was not significant in any of the models. Results are available from authors.

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Acknowledgement

A portion of the work on this study was completed through funding from the National Institute on Drug Abuse Brandeis/Harvard Center on Managed Care and Drug Abuse Treatment (P50-DA10233).

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Authors and Affiliations

  1. State of Maine, Office of Substance Abuse, 41 Anthony Ave, Augusta, ME, 04333, USA

    Debra L. Brucker MPA, PhD

  2. Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454, USA

    Maureen Stewart PhD

Authors
  1. Debra L. Brucker MPA, PhD
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  2. Maureen Stewart PhD
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Correspondence to Debra L. Brucker MPA, PhD.

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Brucker, D.L., Stewart, M. Performance-Based Contracting Within a State Substance Abuse Treatment System: A Preliminary Exploration of Differences in Client Access and Client Outcomes. J Behav Health Serv Res 38, 383–397 (2011). https://doi.org/10.1007/s11414-010-9228-5

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  • DOI: https://doi.org/10.1007/s11414-010-9228-5

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