Improving public addiction treatment through performance contracting: the Delaware experiment.

Area of Science:

• Health Services Research
• Addiction Treatment Policy
• Healthcare Management

Background:

• Delaware transitioned outpatient addiction treatment programs from cost-reimbursement to performance-based contracts in 2002.
• Incentives focused on capacity utilization and patient participation.
• One program did not meet performance requirements.

Purpose of the Study:

• To evaluate the impact of performance-based contracts on addiction treatment programs.
• To identify strategies employed by successful programs under the new contract model.

Main Methods:

• Analysis of program data before and after the implementation of performance-based contracts.
• Identification of successful program strategies, including extended hours, facility improvements, and adoption of evidence-based therapies like Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT).

Main Results:

• Average capacity utilization increased from 54% (2001) to 95% (2006).
• Average patient participation rates improved from 53% to 70%.
• Patient population demographics remained consistent.

Conclusions:

• Performance-based contracts are a feasible and well-received mechanism for addiction treatment programs.
• These contracts can create financial conditions conducive to implementing evidence-based clinical practices.
• The study supports the use of performance incentives to improve addiction treatment outcomes.