DRUG ABUSE TREATMENT UNDER MANAGED CARE--ROLE OF PPOS

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DESCRIPTION: (Applicant's Abstract) The main objective of this study is to understand how drug abuse services are provided in preferred provider organizations (PPOs) and to model decisions to provide these services internally or through a carve-out contract with a specialty vendor. The specific aims for this study include the following: 1. Describe the provision of drug abuse services in PPOs in terms of several factors, including overall plan and market characteristics, and characteristics of the drug abuse services themselves in terms of contracting with vendors, treatment approaches, payment methods and risk sharing, utilization management, provider selection, entry into treatment, benefit design, and quality assurance. 2. Document how the provision of drug abuse services in PPOs changes over time and explore what factors influence these changes. 3. Model why some PPOs provide drug abuse services internally within the plan and other PPOs choose to carve-out drug abuse services to be delivered by a specialty managed behavioral health care organization. To examine questions related to these three specific aims, we will conduct an initial telephone survey and another survey approximately three years later of 240 PPOs in 30 market areas. We will collaborate with the longitudinal, nationally representative Community Tracking Study (CTS) conducted by the Center for Studying Health System Change and funded by the Robert Wood Johnson Foundation. In 30 of the same market areas as CTS and in the year following their health plan survey, we will survey a sample of the same PPOs (stratified into two groups according to how they provide drug abuse services by maintaining a network directly or through contracts with a specialty vendor. Similarly, the second wave of our survey will coordinate and follow-up on the second wave of the CTS survey of health plans. The proposed study of drug abuse treatment services is the first to combine a national survey of PPOs within market areas with a prospective design that will allow us to track how the delivery of drug abuse services in PPOs evolves within the changing health care market. This study will provide systematic information on the nature and extent of these changes.