; Danseco, E.R.; Miller, T.R.
; Zaloshnja, E.
; Romano, E.O.
; and Branch, D.
In Supplement to Alcoholism. Clinical and Experimental Research. 2000 Scientific Meeting of the Research Society on Alcoholism. June 24-29, 2000—Denver, CO
pgs. 117A , (2000)The majority of research into managed behavioral health care focuses on mental health services; alcohol and drug treatments represent only 16% of mental health expenditures. This study has focused on services provided for patients with primary diagnoses that are alcohol-related. It combines an evaluation of system level authorizations for alcohol treatment services by a national managed behavioral health care organization (MBHO) with a targeted prospective study of alcohol treatment outcomes among patients whose care is authorized by a local unit of the MBHO in Pennsylvania. The national data for the authorization study includes 8897 episodes of alcohol treatment with no comorbidities. Episodes were defined by a 6 month clear zone. Multinomial regressions examined four levels of care ranging from acute inpatient to traditional outpatient. Results suggest that less MBHO financial risk is predictive of higher levels of care authorized (e.g., acute/inpatient) with fewer outpatient sessions. This may reflect richer benefits from more traditional indemnity policies. Greater alcohol dependency does predict more and higher levels of care. Pennsylvania, a state with mandated minimum benefits, and which uses ASAM criteria, has a higher level of care authorized than states which do not have these features. In the targeted prospective study, paired intake and 6 month follow data (60% compliance) using the Substance Abuse Outcomes Module (SAOM) showed 53% of the sample to be alcohol abstinent at follow-up. Across the 389 sample pairs currently available, on a 100 point calculated "problem severity scale," baseline sample mean severity scores of 65.3 were reduced to 32.1 at six months (t=12.9, P=.000). Positive change were found in all health status items also (P=.000). Based on the followed sample, therapeutic outcomes at 6 months provided through managed care appear approximately normative.