How are drug abuse treatment programs faring under managed care?

By Catherine Behan
News Office

What does the trend toward managed care mean for drug abuse treatment programs? Two University researchers have been awarded a $1 million-plus grant to find out.

Thomas D'Aunno, Associate Professor in the School of Social Service Administration, and Michael Sosin, the Emily Klein Gidwitz Professor in SSA, will spend the next two and one-half years studying the use of managed care programs in drug treatment. The grant was awarded by the National Institutes of Health/National Institute on Drug Abuse. The researchers want to determine what methods managed care firms are using to control the behavior of drug treatment providers, why they are using them and how they affect the quality of treatment. D'Aunno and Sosin also hope to advance organizational theory by learning more about how organizations respond to uncertainty: Managed care has created a very uncertain environment for treatment providers and managed care firms themselves. "How do such issues as market power, competition and the practices of emerging industry leaders affect managed care firms and the programs they use to control treatment providers?" D'Aunno asks.

Managed care programs, which have dominated health care in recent years, are intermediary programs that operate between the company paying for health care -- a corporation that provides health insurance to employees, for example -- and health-care providers. Managed care programs exist to help health-care professionals provide effective care at the lowest cost.

"The question is, what's the best way to proceed with managed care?" D'Aunno said. "It's important to understand which policies are the most rational and enable health-care professionals to provide the most effective treatment."

For example, some managed care firms might set a cap on the amount of time or money that can be spent for each patient. Others might set rules that determine what kinds of treatment individuals receive.

"Managed care firms use a hodge-podge of mechanisms such as bureaucratic controls or financial controls," D'Aunno said. "They're all over the place. We want to know which managed care companies are using what types of controls and what are the effects of those controls."

Sosin added, "We want to know what kinds of services people get under different managed care systems -- the level of quality and the appropriateness of after-care for example. We want to determine the relative impacts of various services on multiple outcomes."

The project is an outgrowth of a long-term multiple-part study of the effectiveness of drug treatment in the United States. D'Aunno has been principal investigator in the multiple studies, which have been conducted by faculty and students from Chicago as well as the University of Michigan. The studies have been funded by the National Institute on Drug Abuse. Sosin has researched drug abuse treatment programs among homeless adults and is interested in issues of standardization and flexibility in the relations between policies and human service organizations.

The research project will extend from the ongoing study by D'Aunno. That project contains a national sample of substance abuse treatment providers. The researchers will ask the providers to give them a list of all the firms working with them and then do a random sample of the firms.

The researchers will subcontract part of the research work with the University's National Opinion Research Center.

Preliminary results from the ongoing study show some apparent trends in what works in substance-abuse care. For example, D'Aunno said, statistics show that the higher the number of visits patients get, the higher the rate of success.

"We want to know if some managed care companies can limit the number of visits to control costs, but still see strong benefits for the patients," D'Aunno said. "The buyers of treatment services -- for example, businesses that work with managed care for their employees' health care -- want health care to be as economical as possible. They also want their employees to be happy. Our study will plot the relationships between these employers, substance abuse providers and managed care firms in the middle."

Sosin says the research might not pick a "winning" strategy. "It might be that no specific way is the best," he said. "There are probably trade-offs with every strategy agencies use."