TRI science addiction Engaging Detoxification Patients into Continuing Rehabilitation: Sean J. Haley A. Thomas McLellan Mady Chalk Partial Success From Performance-Contracting

TRI science addiction Introduction Underlying Assumption: Patients who “enter” treatment they will engage and participate, leading to less need for re- detoxification Goals of the Contract : 1.To increase the percentage of all clients completing detoxification and “entering” another level of care 2.Maintain full (90%) detoxification occupancy

TRI science addiction Contract Design: Base + Incentive Base has 2 components: 90% reimbursement for 90% or better occupancy & 10% reimbursement if 25% or more of medically completing clients enter OP or residential tx within 7 days $500 for every 3+ client that reached 30 days residential or 60 days OP tx

TRI science addiction 90% Occupancy June Was Utilization Maintained?

TRI science addiction How Long Was Detox? Mean LOS for Completers: All = 5.6 days 3+ = 5.7 days Mean LOS for Dropouts: All = 2.8 days 3+ = 2.8 days

TRI science addiction % Entering Treatment

TRI science addiction What Behaviors Changed? –Established MOUs Detox and OPT staff had reciprocity –Invited OP providers to give on-site orientations Intent was to complete admission info. –Case Managers visited and called discharged patients –Provided transportation to Tx for all

TRI science addiction Treatment “Entry” 46% OPT 54% RES N=322 pts & 359 detoxes Where Did the 359 Completers Go? Note – About the Same for 3+ Pts

TRI science addiction 3+ Client Episodes that Remained in Tx 61% (n=20) 39% (n=11) N=31 Point – VERY Few 3+ patients engaged In OPT care

TRI science addiction Did 3+ Client Tx Entry and Retention Improve? WE DO NOT KNOW % of 3+ client detox episodes resulted in treatment entry (residential or outpatient) 7% of 3+ client detox episodes resulted in 30 day residential or 60 day OP treatment BUT NO BASELINE DATA SO, HERE IS THE NEED FOR FURTHER RESEARCH

TRI science addiction Problems? 70% of 3+ Clients Homeless –Little housing available Possible Perverse OPT incentive –Prevailing (successful) performance contract in OPT may count against OPT performance – needs more research and further contract work with the State Misplaced Incentives –Not enough ($500) ? –Not under Detox control –Consider push-pull incentives placed on both detox and treatment organizations

TRI science addiction What’s Next? Continue work with State to redefine some aspects of the contract, incl. collecting baseline data for comparison with 3+ results Work with State to reconsider the 25% bar, with the idea of raising the expectations for admissions to treatment following detox Create new research study with State focused on “dropouts” from detox

TRI science addiction What’s Next ? (con’t) Explore how amount and placement of incentives differs when contracting across organizations More incentives on “pull” side Explore additional housing options Explore continuing buprenorphine for maintenance in treatment

TRI science addiction Acknowledgements DSAMH: Renata Henry, Kim Beniquez, Maurice Tippett & Wendy Nurse NET: James Larks and staff TRI: Sean Haley, Mady Chalk, Jack Kemp, Adam Brooks & Karen Dugosh