Managed care and outpatient substance abuse treatment intensity.

This study examines the extent to which managed care behavioral controls are associated with treatment intensity in outpatient substance abuse treatment facilities. Data are from the 1995 National Drug Abuse Treatment System Survey, a nationally representative survey that includes over 600 provider organizations with a response rate of 86%. Treatment intensity is measured in three ways: (1) the number of months clients spend in outpatient drug treatment, (2) the number of individual treatment sessions clients receive over the course of treatment, and (3) the number of group treatment sessions clients receive over the course of treatment. After accounting for selection bias and controlling for market, organization, and client characteristics, there is no significant relationship between the scope of managed care oversight and treatment intensity. However, the stringency of managed care oversight activities is negatively associated with the number of individual and group treatment sessions received over the course of treatment.

Selective contracting in managed care: the case of substance abuse treatment.

The authors address two critical questions concerning managed care and outpatient substance abuse treatment organizations. Specifically, they consider (1) to what extent selective contracting occurs between managed care firms and treatment providers and (2) what attributes of treatment providers and their operating environments are associated with selective contracting. Using data from a nationally representative sample of outpatient treatment organizations, the authors find evidence of systematic selection. Several indicators of providers' quality and costs, including accreditation status, private ownership, size, and prior experience with managed care, are positively associated with managed care contracting. By contrast, units providing methadone treatment are less likely to be involved in managed care. To a lesser extent, characteristics of treatment providers' operating environment, including extent of competition based on costs and attributes of the Medicaid managed care program, are also positively associated with managed care contracting.

Managed care and technical efficiency in outpatient substance abuse treatment units.

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.

Directors' perceptions of the effects of managed care in outpatient substance abuse treatment.

This study examines the perceptions of unit directors' regarding the effects of managed care on outpatient treatment and operations. Specifically, we propose that perceptions vary as a function of managed care penetration, managed care complexity, and the stringency of managed care oversight procedures. Data are from a nationally representative sample survey of 236 outpatient substance abuse treatment organizations conducted in 1995. Study findings support the thesis that directors' perceptions vary systematically with specific attributes of managed care. Specifically, directors' perceptions of positive managed care effects are associated with two managed care oversight procedures: (a) managed care limits on the number of sessions provided; and (b) managed care requirements for follow-up after treatment. Directors perceptions of negative effects of managed care are significantly related to (a) managed care penetration, (b) managed care complexity; and (c) four different managed care oversight procedures. These results have implications for treatment given the rapid growth in managed behavioral care.

Beyond adoption to sustained use: telemedicine for rural communities.

The objective of this paper is to identify factors that affect the sustained use of telemedicine in rural communities and to suggest possible ways to improve such utilization. We draw on innovation and network theory to develop hypotheses about conditions that will hinder or facilitate sustained use of telemedicine. Telemedicine systems are expected to achieve sustained use in communities with higher physician-to-population ratios, greater availability of nonphysician providers, and greater consumer knowledge of and support for telemedicine. Additionally, telemedicine is more likely to be used in settings where hospital medical staff structures use contractual arrangements that encourage the use of telemedicine or reimburse through capitated systems. Rural physicians are more likely to use telemedicine if they have previous experience in facilities that serve as telemedicine hubs and if they have strong relationships with physicians in a hub location or with local physicians who are supportive of telemedicine. Physicians whose primary offices are geographically closer to the remote telemedicine installation are more likely to order telemedicine consultations for their patients than are their counterparts further away. Also, telemedicine systems that are well managed and easy to use are more likely to achieve sustained utilization by rural physicians. These hypotheses should be considered by supporters, providers, and managers of telemedicine. A proactive approach to managing telemedicine networks, with an emphasis on the issues raised here, should help telemedicine achieve its potential, namely, improved access and enhanced quality and efficiency of health services in rural communities.