Privately incorporated addiction treatment providers find outcome measurement challenging, as typical research funding is designated for nonprofit corporations, favoring publicly funded large-scale outcome studies. Private providers lacking deep pockets often forgo outcome research. But achieving and improving patient care via collection of meaningful local outcome data need not depend on corporate status; private providers and payers can collaborate on successful outcome evaluation projects.
This article outlines a simple, self-sustaining outcome pilot combining clinical and case management resources appearing to benefit patients, providers and payers. Though the study is in its early stages, the novelty of the design as a possible sustainable template for private-sector outcome collaboration may be as significant as the data byproducts.
Nontraditional partners ally
Payer/for-profit provider relationships can range from cooperative to adversarial; they are also complex and often misunderstood. Minnesota’s Medica Behavioral Health and New Beginnings at Waverley, LLC (New Beginnings), one of Minnesota’s largest private treatment providers, previously collaborated on developing a specialty methamphetamine treatment methodology in response to the rural Minnesota meth epidemic. Recently, Medica Behavioral Health approached New Beginnings again to collaborate on design and implementation of a multi-program outcome pilot examining internal and external treatment measures collected on patients up to six months post residential treatment, the “Medica Behavioral Health Outcomes Study.”
Medica Behavioral Health’s pilot goal as insurer was to “extend” and combine internal patient utilization data with that within the care environment to jointly assess and potentially influence outcome variables, utilization patterns, recidivism, care quality, and follow-up services. The critical focus for both parties was the “golden period” (six months post treatment).
Medica Behavioral Health’s initial charge to New Beginnings was to operationalize a “simple research study designed to help measure and improve chemical dependency and co-occurring disorder treatment outcomes.” During 2011, Medica Behavioral Health provided baseline criteria for the pilot in areas including communication, funding, patient enrollment/engagement, treatment variables, and staffing. New Beginnings completed and operationalized the resulting design, which targeted three main areas: patient selection and enrollment, researcher competencies, and data gathering and analyses. To date, 62 of 64 New Beginnings patients who have been approached to participate have enrolled.
Patient enrollment, critical to developing patient engagement and rapport, often determines participant retention. The study design incorporates a clinical “navigator” paralleling Medica Behavioral Health’s own internal utilization review case manager/navigators. The New Beginnings navigator is a half-time employee devoted to achieving patient enrollment; assessing treatment variables; establishing discharge plans; and tracking, motivating, supporting and case managing patients for up to six months after treatment in monthly telephonic or live encounters. Monthly support calls involve multidimensional assessment and case management for medical issues, mental health follow-up/screenings, and counseling support.
The navigator is a licensed clinician achieving clinical contacts and providing counseling, resources and support, thereby rendering the service a modified form of reimbursable outpatient care akin to community mental health case management, which is a foundation of successful mental health outcomes. Reimbursement for patient contacts requires thorough periodic review and meetings between the pilot participants.
The pilot design includes three simple phases:
- Phase 1: Enrollment. The navigator approaches residential treatment patients after stabilization for an “enrollment meeting” for voluntary pilot participation. Consenting patients receive information, review expectations, and sign consent to receive individualized ongoing treatment planning and support for six months after treatment, including monthly check-ins and assessments.
- Phase 2: Community Preparation and Transition. Prior to discharge, patients review progress on treatment goals (measured across ASAM dimensions) and accomplishments, and also identify short- and long-term discharge planning goals; mental health and substance use continuing care goals; housing and support plans and resources; 12-Step involvement; service commitments; and access and use of services for higher levels of care such as emergency and urgent care.
- Phase 3: Managing Participation and Success. This involves monthly evaluation and support by telephone or in person on treatment goals, medical status, quality of sober support system, employment, 12-Step involvement, achievement of follow-up appointments, coordination of transportation and resources, and assistance accessing other services including physical and mental health, housing, social services, or other community supports.
Ninety-seven percent of patients who were approached have enrolled, indicating strong response to enrollment requests. Despite high enrollment, high attrition occurred, with only 23% of enrollees (enrollment is continuous) completing three months, and 9% completing six of the seven months to date. Among patients completing three months, having an active support system, engaging in sober activities and attending 12-Step meetings appear to be consistent variables correlated to ongoing compliance, engagement and abstinence.