Measuring and improving quality is a constant challenge for managed care organizations. Under a carve-out for mental health and substance abuse treatment funded by state government, providers must seek authorization for each admission or extension of stay. Each type of substance abuse service has been classified based on ASAM principles from levels I through IV. Using these data, the state has defined “connection to care” as a transition from a higher to a lower level (generally desirable, scored 1), while a readmission is a movement within a brief period to the same or a higher level (generally undesirable, scored 0). Clients from higher levels for whom no authorization is requested, or with authorization but no services within 30 days, represent intermediate outcomes. We thus calculated a transition score for 100,000 admissions by 50,000 clients from 1998 through 2000. The score is useful for adjusting providers’ performance for case mix by examining how client characteristics and the client’s admissions in the previous 6 and 12 months predict his subsequent transitions. In preliminary analyses, age, gender, race, ethnicity and outcomes for the two previous admissions all proved statistically significant predictors of transitions from detoxification. For a treatment provider, the score provides an indicator of its success in managing clients’ transitions to the next (follow-up) level of care. This authorization-based score, adjusted for case mix, can allow a managed care organization to identify more effective providers while not penalizing facilities that admit more challenging cases.
Learning Objectives: After this session, attendees will be able to understand how an administrative data base can be used to assess quality of care in substance abuse treatment, how to develop profiles of providers, and how to adjust profiles for the case mix of clients.
Keywords: Substance Abuse Treatment, Recovery
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.