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Clinical-based vs insurance-based recommendations for substance abuse treatment level
E Gondolf1, K Coleman, S Roman
1Mid-Atlantic Addiction Training Institute, Indiana University of Pennsylvania 15705, USA.
Substance Use & Misuse
|July 1, 1996
Summary
This study found high agreement between addiction treatment recommendations from the American Society of Addiction Medicine (ASAM) criteria and insurance (MCO) criteria. ASAM
Area of Science:
- Addiction Medicine
- Healthcare Policy
- Treatment Efficacy
Background:
- Discrepancies between clinical and insurance-based treatment recommendations can impact patient care.
- Understanding the alignment of criteria is crucial for effective addiction treatment delivery.
Purpose of the Study:
- To assess the agreement between American Society of Addiction Medicine (ASAM) criteria and Managed Care Organization (MCO) criteria for addiction treatment levels.
- To determine the extent to which ASAM-recommended treatments are implemented in practice.
Main Methods:
- An exploratory study involving 250 patients across three treatment facilities in Western Pennsylvania.
- Cross-tabulation analysis to compare ASAM and MCO recommendations and actual treatment received.
Main Results:
- 85% agreement was found between ASAM and MCO recommendations for treatment levels.
- 93% of ASAM-recommended treatments were implemented as the actual patient care.
Conclusions:
- A significant convergence exists between ASAM and MCO criteria for addiction treatment.
- Clinical recommendations based on ASAM criteria are largely followed in practice, indicating strong adherence.