Joint Effort To Study Drug Abuse Care

Researchers at Harvard and Brandeis Universities were awarded a $1.3 million grant from the National Institute of Drug Abuse last week to undertake a five-year study into the most medically and financially effective ways to combat substance abuse problems through managed care.

“The point of the grant is to look at how various kinds of organizations and financing arrangements affect the quality and cost of substance abuse care...to help real world programs do a better job with the money they put into substance abuse programs and to help [them] redesign how they do things,” said Harvard Medical School (HMS) Morris Professor of Health Economics Richard G. Frank, who will be a co-principal investigator on the project. “Hopefully it can really make a difference.”

Another principal investigator, Constance Horgan, who is director of the Center for Behavioral Health at Brandeis University’s Heller School, was not available for comment. Horgan has worked on numerous projects examining how health services are provided in the changing managed care environment, according to the Heller School website.

Brandeis and Harvard’s health departments have worked on similar projects since the mid-90s, during which they also received a significant grant.

The research project is divided into four main areas. One focus of the study is a program run by the state of Connecticut that “rewards medical providers for doing a good job with Medicaid beneficiaries who abuse substances,” Frank said. The researchers will try to determine whether such monetary incentives are effective in encouraging providers to produce better results in substance abuse recoveries.

A second area of inquiry is the way in which treatment and welfare reform interact for people with substance abuse problems.

“Some states really integrate welfare information…while other states say you can’t have treatment until you get a job,” Frank said. “We are seeing how well people do under those two different circumstances.”

HMS Professor of Health Economics Thomas G. McGuire, another co-investigator of the study, said that welfare reform is “to some degree a one-size-fits-all policy and we are trying to figure out how this aggregate policy suits the most disadvantaged.”

A third aspect of the study is to look at private managed care companies individually and to examine how costs and outcomes differ when Employee Assistance Programs (EAPs) are integrated with managed care.

“[EAPs] typically work with management and teach them what the workplace symptoms of substance abuse are and to sensitize supervisors and managers to them and to facilitate those employees getting help...[while managed care tries] to arrange for substance abuse care in a way that reduces the cost and increases efficiency,” said William C. Barron, a clinician with Harvard’s EAP.

“The hypothesis is that when these two are linked, you might get better outcomes in terms of costs,” Frank said. “If we learn that integrating them into one thing that does both as opposed to keeping them separate, then perhaps they’ll redesign what they offer employers, so for same amount of money they can offer more.”

Data for the EAP study will come from Managed Health Network, Inc. a mental and behavioral health services company.

The researchers will also study whether equal coverage of substance abuse treatment, compared with coverage of more standard treatments, is affordable or practical.

“I think there is interest in employer and employee groups in dealing with substance abuse, but the problem is that they’re not in the position to finance research and are not sure what right thing for their employees is,” McGuire said.