Evidence map›Paper›PMID 33143701›Full record

ArticleBMC health services research2020

Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study.

Maria E Torres, Mary Brolin, Lee Panas, Grant Ritter, Dominic Hodgkin, Margaret Lee, Elizabeth Merrick, Constance Horgan, Jonna C Hopwood, Andrea Gewirtz and 2 more

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In one paragraph

Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Maria E TorresBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA. metorres@smith.edu.ORCID http://orcid.org/0000-0001-6110-6384
Mary BrolinBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Lee PanasBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Grant RitterBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Dominic HodgkinBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Margaret LeeBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Elizabeth MerrickBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Constance HorganBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.
Jonna C HopwoodMassachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA.
Andrea GewirtzMassachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA.
Natasha De MarcoHarvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA.
Nancy LaneBrandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA.

Funding

Centers for Medicare and Medicaid Services 1C1CMS331059-01-00
6 · The paper itself

Abstract

backgroundAcute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service.

methodsWe analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings.

resultsClients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model.

conclusionsAddiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed.

Indexed as

AftercarePatient DischargeFeasibility StudiesHumansMassachusettsMedicaidUnited StatesCase rateDetoxificationMental health recoveryPatient engagementPatient navigationPayment reformRecovery supportSubstance addictionThird-party payers

Identifiers

PMID33143701
PMCPMC7607694

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.