The introduction of Accountable Care Organizations (ACO) to behavioral health – including treatment for individuals with substance use disorders (SUD) and mental illness – is likely to incentivize providing high quality care in a cost efficient manner.
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A related health care policy involves the use of “pay-for-performance” (P4P) systems, where providers are paid for services depending on outcomes of patients rather than services rendered. The idea behind this initiative is that incentivizing clinicians to produce good outcomes will lead to better patient care and enhanced remission and recovery rates.
Understanding empirically how the implementation of these systems influences treatment and recovery can inform modifications at the micro-level (e.g., patient care) and macro-levels (e.g., treatment program approaches and local and state behavioral health policies).
In the current study, Mason et al. evaluated the impact of a pilot P4P program within 8 SUD treatment centers in the United Kingdom during 2012-2013.
Primary outcomes were:
It is worth mentioning that treatment centers were paid not only for “successful treatment completion” but also if patients were not re-admitted to treatment or to the criminal justice system within 12 months after discharge. However, these latter two payment criteria were not examined in the current study.
To measure the impact of the pilot program on successful treatment completion and treatment drop-out, researchers used a “difference-in-difference” analysis, measuring the difference in outcomes before and after the pilot program was implemented among the 8 participating sites and subtracting the difference during the same time period among the 141 non-participating sites.
They also conducted several supplemental analyses comparing outcomes of patients from the eight participating programs to:
As non-participating programs could also adopt the P4P system, authors also examined differences between P4P and non-P4P sites. They performed analyses at the level of the individual (N = 167,372 in non-participating sites and N = 11,488 in participating sites during 2012-2013), controlling not only for the similarity in patients that was accounted for by attending the same program (“proportion of total variance accounted for by within-site correlation”), but also for several other individual factors, including demographic characteristics, substance use profiles, and having been referred by the criminal justice system.
Results showed that sites in the P4P program did worse than non-participating sites. Specifically, non-participating sites had 1.3% fewer patients successfully completing treatment, and 0.9% more patients drop out of treatment. These findings were consistent across each of the supplementary analyses.
This was unexpected as the point of the program was to enhance patients’ outcomes.
Although the actual difference was somewhat small in magnitude, a reliable difference of this size in tens of thousands of patients could have a notable negative effect from a broader public health perspective. Authors speculated that, among P4P programs, receiving less money for a patient if he/she is readmitted to treatment within the year after discharge may have explained the lower proportion of “successful treatment completions” among patients attending the pilot program sites. Specifically, a provider from a P4P program may have been less likely to discharge a patient, even if doing well, if there were any concerns that the patient might relapse and require treatment re-admission within a year (e.g., due to multiple drug users in their social network).
They also hypothesized that the nature of treatment may have changed in relation to the P4P system leading to greater likelihood of treatment drop-out. Although they do not speculate further, one example may be that patients in a publicly-funded health care system are turned off by providers that emphasize results over process.
Mason, T., Sutton, M., Whittaker, W., McSweeney, T., Millar, T., Donmall, M., . . . Pierce, M. (2015). The impact of paying treatment providers for outcomes: difference-in-differences analysis of the ‘payment by results for drugs recovery’ pilot. Addiction. doi: 10.1111/add.12920
l
A related health care policy involves the use of “pay-for-performance” (P4P) systems, where providers are paid for services depending on outcomes of patients rather than services rendered. The idea behind this initiative is that incentivizing clinicians to produce good outcomes will lead to better patient care and enhanced remission and recovery rates.
Understanding empirically how the implementation of these systems influences treatment and recovery can inform modifications at the micro-level (e.g., patient care) and macro-levels (e.g., treatment program approaches and local and state behavioral health policies).
In the current study, Mason et al. evaluated the impact of a pilot P4P program within 8 SUD treatment centers in the United Kingdom during 2012-2013.
Primary outcomes were:
It is worth mentioning that treatment centers were paid not only for “successful treatment completion” but also if patients were not re-admitted to treatment or to the criminal justice system within 12 months after discharge. However, these latter two payment criteria were not examined in the current study.
To measure the impact of the pilot program on successful treatment completion and treatment drop-out, researchers used a “difference-in-difference” analysis, measuring the difference in outcomes before and after the pilot program was implemented among the 8 participating sites and subtracting the difference during the same time period among the 141 non-participating sites.
They also conducted several supplemental analyses comparing outcomes of patients from the eight participating programs to:
As non-participating programs could also adopt the P4P system, authors also examined differences between P4P and non-P4P sites. They performed analyses at the level of the individual (N = 167,372 in non-participating sites and N = 11,488 in participating sites during 2012-2013), controlling not only for the similarity in patients that was accounted for by attending the same program (“proportion of total variance accounted for by within-site correlation”), but also for several other individual factors, including demographic characteristics, substance use profiles, and having been referred by the criminal justice system.
Results showed that sites in the P4P program did worse than non-participating sites. Specifically, non-participating sites had 1.3% fewer patients successfully completing treatment, and 0.9% more patients drop out of treatment. These findings were consistent across each of the supplementary analyses.
This was unexpected as the point of the program was to enhance patients’ outcomes.
Although the actual difference was somewhat small in magnitude, a reliable difference of this size in tens of thousands of patients could have a notable negative effect from a broader public health perspective. Authors speculated that, among P4P programs, receiving less money for a patient if he/she is readmitted to treatment within the year after discharge may have explained the lower proportion of “successful treatment completions” among patients attending the pilot program sites. Specifically, a provider from a P4P program may have been less likely to discharge a patient, even if doing well, if there were any concerns that the patient might relapse and require treatment re-admission within a year (e.g., due to multiple drug users in their social network).
They also hypothesized that the nature of treatment may have changed in relation to the P4P system leading to greater likelihood of treatment drop-out. Although they do not speculate further, one example may be that patients in a publicly-funded health care system are turned off by providers that emphasize results over process.
Mason, T., Sutton, M., Whittaker, W., McSweeney, T., Millar, T., Donmall, M., . . . Pierce, M. (2015). The impact of paying treatment providers for outcomes: difference-in-differences analysis of the ‘payment by results for drugs recovery’ pilot. Addiction. doi: 10.1111/add.12920
l
A related health care policy involves the use of “pay-for-performance” (P4P) systems, where providers are paid for services depending on outcomes of patients rather than services rendered. The idea behind this initiative is that incentivizing clinicians to produce good outcomes will lead to better patient care and enhanced remission and recovery rates.
Understanding empirically how the implementation of these systems influences treatment and recovery can inform modifications at the micro-level (e.g., patient care) and macro-levels (e.g., treatment program approaches and local and state behavioral health policies).
In the current study, Mason et al. evaluated the impact of a pilot P4P program within 8 SUD treatment centers in the United Kingdom during 2012-2013.
Primary outcomes were:
It is worth mentioning that treatment centers were paid not only for “successful treatment completion” but also if patients were not re-admitted to treatment or to the criminal justice system within 12 months after discharge. However, these latter two payment criteria were not examined in the current study.
To measure the impact of the pilot program on successful treatment completion and treatment drop-out, researchers used a “difference-in-difference” analysis, measuring the difference in outcomes before and after the pilot program was implemented among the 8 participating sites and subtracting the difference during the same time period among the 141 non-participating sites.
They also conducted several supplemental analyses comparing outcomes of patients from the eight participating programs to:
As non-participating programs could also adopt the P4P system, authors also examined differences between P4P and non-P4P sites. They performed analyses at the level of the individual (N = 167,372 in non-participating sites and N = 11,488 in participating sites during 2012-2013), controlling not only for the similarity in patients that was accounted for by attending the same program (“proportion of total variance accounted for by within-site correlation”), but also for several other individual factors, including demographic characteristics, substance use profiles, and having been referred by the criminal justice system.
Results showed that sites in the P4P program did worse than non-participating sites. Specifically, non-participating sites had 1.3% fewer patients successfully completing treatment, and 0.9% more patients drop out of treatment. These findings were consistent across each of the supplementary analyses.
This was unexpected as the point of the program was to enhance patients’ outcomes.
Although the actual difference was somewhat small in magnitude, a reliable difference of this size in tens of thousands of patients could have a notable negative effect from a broader public health perspective. Authors speculated that, among P4P programs, receiving less money for a patient if he/she is readmitted to treatment within the year after discharge may have explained the lower proportion of “successful treatment completions” among patients attending the pilot program sites. Specifically, a provider from a P4P program may have been less likely to discharge a patient, even if doing well, if there were any concerns that the patient might relapse and require treatment re-admission within a year (e.g., due to multiple drug users in their social network).
They also hypothesized that the nature of treatment may have changed in relation to the P4P system leading to greater likelihood of treatment drop-out. Although they do not speculate further, one example may be that patients in a publicly-funded health care system are turned off by providers that emphasize results over process.
Mason, T., Sutton, M., Whittaker, W., McSweeney, T., Millar, T., Donmall, M., . . . Pierce, M. (2015). The impact of paying treatment providers for outcomes: difference-in-differences analysis of the ‘payment by results for drugs recovery’ pilot. Addiction. doi: 10.1111/add.12920
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