Sujaya Parthasarathy

Utilization and cost impact of integrating substance abuse treatment and primary Care

Objective. To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. Research Design. Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO’s primary care clinics independently from substance abuse treatment. Subjects. Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. Measures. Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. Results. For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care–Based Model

431.12 to

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment.

200.03 (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. Conclusions. (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.

The role of continuing care in 9-year cost trajectories of patients with intakes into an outpatient alcohol and drug treatment program.

OBJECTIVES How best to provide ongoing services to patients with substance use disorders to sustain long-term recovery is a significant clinical and policy question that has not been adequately addressed. Analyzing nine years of prospective data for 991 adults who entered substance abuse treatment in a private, nonprofit managed care health plan, this study aimed to examine the components of a continuing care model (primary care, specialty substance abuse treatment, and psychiatric services) and their combined effect on outcomes over nine years after treatment entry. METHODS In a longitudinal observational study, follow-up measures included self-reported alcohol and drug use, Addiction Severity Index scores, and service utilization data extracted from the health plan databases. Remission, defined as abstinence or nonproblematic use, was the outcome measure. RESULTS A mixed-effects logistic random intercept model controlling for time and other covariates found that yearly primary care, and specialty care based on need as measured at the prior time point, were positively associated with remission over time. Persons receiving continuing care (defined as having yearly primary care and specialty substance abuse treatment and psychiatric services when needed) had twice the odds of achieving remission at follow-ups (p<.001) as those without. CONCLUSIONS Continuing care that included both primary care and specialty care management to support ongoing monitoring, self-care, and treatment as needed was important for long-term recovery of patients with substance use disorders.

Costs of care for persons with opioid dependence in commercial integrated health systems

BACKGROUND Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. METHODS We used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13-18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. RESULTS Each additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at

Health Care Services Use by Adolescents with Intakes into an Outpatient Alcohol and Drug Treatment Program

145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. CONCLUSIONS The findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings.

Medicaid patients in a private health maintenance organization: patterns of chemical dependency treatment.

Background:The importance of a continuing care approach for substance use disorders (SUDs) is increasingly being recognized. Our prior research found that a Continuing Care model for SUDs that incorporates 3 components (regular primary care, and specialty SUD and psychiatric treatment as needed) is beneficial to long-term remission. The study builds on this work to examine the cost implications of this model. Objectives:To examine associations between receiving Continuing Care and subsequent health care costs over 9 years among adults entering outpatient SUD treatment in a private nonprofit, integrated managed care health plan. We also compare the results to a similar analysis of a demographically matched control group without SUDs. Study Design:Longitudinal observational study. Measures:Measures collected over 9 years include demographic characteristics, self-reported alcohol and drug use and Addiction Severity Index, and health care utilization and cost data from health plan databases. Results:Within the treatment sample, SUD patients receiving all components of Continuing Care had lower costs than those receiving fewer components. Compared with the demographically matched non-SUD controls, those not receiving Continuing Care had significantly higher inpatient costs (excess cost=

Services integration and cost-effectiveness

65.79/member-month; P < 0.01) over 9 years, whereas no difference was found between those receiving Continuing Care and controls. Conclusions:Although a causal link cannot be established between receiving Continuing Care and reduced long-term costs in this observational study, the findings reinforce the importance of access to health care and development of interventions that optimize patients receiving those services and that may reduce costs to health systems.

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics.

BackgroundWhen used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.MethodsThe objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences.ResultsPatients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = 

Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California

13,578; vs. mean health care costs with no addiction treatment =