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 on ID# 049910.) The group recommended that a report be produced on the topic, including a closer examination of efforts in four states.

Key Findings

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.

Key Recommendations

Researchers identified five areas that need further attention and research:

• States need help to develop "memoranda of understanding" across state government agencies with authority over various funding streams as a means of expanding collaboration, maximizing funding and creating incentives for quality improvement.
• The unintended consequences of existing incentives need to be studied more comprehensively to inform better state purchasers' decisions as they leverage their buying power.
• More attention needs to be paid to ensuring that a more diverse group of providers is brought into the discussion.
• States need assistance in developing joint contracting models that would allow for purchasing of services across the continuum of care regardless of program ownership or management.
• Research should be conducted on the role of consumers in improving the quality of substance use-disorder treatment, especially in supporting a chronic illness model of care.

Funding

RWJF provided the center with a grant of $13,915 from May 2005 to June 2005 to support research and writing of the paper.

After the Program

According to the co-director of the project, Stephen Somers, Ph.D., the report's findings contributed to the design of a three-day meeting — the Resources for Recovery Purchasing Institute — held by the Center for Health Care Strategies in February 2006.

The meeting was conducted under a subcontract from the Technical Assistance Collaborative. John O'Brien at the collaborative was the program director for the RWJF national program Resources for Recovery: State Practices that Expand Treatment Opportunities. The meeting kicked off the program's technical assistance efforts. (See the Program Results on the program.)