Joanna Volpe-Vartanian, MS, LICSW¹, Constance M. Horgan, ScD², Deborah W. Garnick, ScD³, Elizabeth L. Merrick, PhD, MSW³, and Dominic Hodgkin, PhD⁴. (1) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 35,415 South St, Waltham, MA 02454, (617) 734-5108, jvolpevartanian@aol.com, (2) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, (3) Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, (4) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454

The management and delivery of substance abuse services under commercial managed care plans have been undergoing rapid change. Quality improvement is a crucial concern regardless of whether health plans provide behavioral health services directly or through contracting with specialty vendors, an arrangement known as a “carve-out,” now the dominant form of behavioral health services provision. Health plans use a variety of approaches to measuring and improving quality. The Brandeis Survey on Alcohol, Drug Abuse and Mental Health Services collected data from over 400 health plans in 60 markets, resulting in national estimates of benefits provisions. The survey was administered in 1999 and again in 2003, allowing us to examine any changes in the use of various quality measurement strategies. Both surveys consist of two separate modules, administrative and clinical. Results from the clinical module provide important data on how managed care organizations conduct quality-related activities using structural, process, and outcomes approaches. These include patient satisfaction surveys, performance indicators, practice guidelines and outcomes assessments. Our 1999 survey found that less than half of respondents assessed clinical outcomes, leading us to include a question on the 2003 survey about how useful respondents found this particular tool. The surveys also analyze how these activities vary by contracting arrangement; whether there are changes in prevalence over time; and whether the relationship between contracting and quality management has changed over time. These results have important implications for quality, since managed care organizations reported considerable variation in the prevalence and characteristics of quality efforts.

Learning Objectives:

• Participants will be able to demonstrate knowledge of how health plans conduct quality-related activities for substance abuse services. Participants will be able to identify a range of contracting choices, the prevalence of each of these, and to explicate how contracting choices may relate to quality management.

Presenting author's disclosure statement:
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.