In 2005, staff at the Center for Health Care Strategies produced a paper examining how state governments employ "purchasing levers" to encourage the use of evidence-based practices in the field of substance abuse treatment.
States may use creative financing and delivery strategies, or purchasing levers, to encourage substance abuse treatment providers to use evidence-based practices. Purchasing levers can be used to drive service coordination, link reimbursement to outcomes, encourage multiagency collaboration and ensure accountability.
Under a previous grant awarded by the Robert Wood Johnson Foundation (RWJF), the center convened a meeting of a small group of purchasing officials to identify how states might use their roles as purchasers/licensors of substance-abuse treatment services to improve the quality of these services. (See Program Results Report on ID# 049910.) The group recommended that a report be produced on the topic, including a closer examination of efforts in four states.
The investigators reported their findings in a 43-page paper, Identifying State Purchasing Levers for Promoting the Use of Evidence-Based Practice in Substance Abuse Treatment, (available online). The paper includes in-depth descriptions of efforts in the four states — Oregon, Iowa, Delaware and Massachusetts — to use such levers.
Key findings include:
- Some state agencies are using contractual levers, such as incentives or penalties, to engage in general quality improvement in the treatment of substance use disorders.
- Although a number of states are engaged in projects and programming to promote the implementation of evidence-based practices, it appears that a significantly smaller number of states are implementing such practices on a systematic basis.
- It appears that the linkage between purchasing levers and the use of evidence-based practices in treatment services is generally not occurring in most states.