Abstract：
BACKGROUND:Some US payers are starting to vary payment to providers depending on patient outcomes, but this approach is rarely used in substance use disorder (SUD) treatment. PURPOSE:We examine the feasibility of applying a pay-for-outcomes approach to SUD treatment. METHODS:We reviewed several relevant literatures: (1) economic theory papers that describe the conditions under which pay-for-outcomes is feasible in principle; (2) description of the key outcomes expected from SUD treatment, and the measures of these outcomes that are available in administrative data systems; and (3) reports on actual experiences of paying SUD treatment providers based on patient outcomes. RESULTS:The economics literature notes that when patient outcomes are strongly influenced by factors beyond provider control and when risk adjustment performs poorly, pay-for-outcomes will increase provider financial risk. This is relevant to SUD treatment. The literature on SUD outcome measurement shows disagreement on whether to include broader outcomes beyond abstinence from substance use. Good measures are available for some of these broader constructs, but the need for risk adjustment still brings many challenges. Results from two past payment experiments in SUD treatment reinforce some of the concerns raised in the more conceptual literature. CONCLUSION:There are special challenges in applying pay-for-outcomes to SUD treatment, not all of which could be overcome by developing better measures. For SUD treatment it may be necessary to define outcomes more broadly than for general medical care, and to continue conditioning a sizeable portion of payment on process measures.
journal_name
Drug Alcohol Dependjournal_title
Drug and alcohol dependenceauthors
Hodgkin D,Garnick DW,Horgan CM,Busch AB,Stewart MT,Reif Sdoi
10.1016/j.drugalcdep.2019.107735subject
Has Abstractpub_date
2020-01-01 00:00:00pages
107735eissn
0376-8716issn
1879-0046pii
S0376-8716(19)30512-5journal_volume
206pub_type
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journal_title：Drug and alcohol dependence
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
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journal_title：Drug and alcohol dependence
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/j.drugalcdep.2015.06.037
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章,多中心研究,随机对照试验
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更新日期：2015-05-01 00:00:00
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journal_title：Drug and alcohol dependence
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pub_type： 杂志文章,多中心研究
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更新日期：2007-03-16 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
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journal_title：Drug and alcohol dependence
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章,随机对照试验
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journal_title：Drug and alcohol dependence
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pub_type： 杂志文章
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
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更新日期：2014-05-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
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更新日期：2020-01-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/s0376-8716(99)00119-2
更新日期：2000-05-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/j.drugalcdep.2008.09.012
更新日期：2009-02-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章,多中心研究
doi：10.1016/j.drugalcdep.2006.10.009
更新日期：2007-05-11 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/j.drugalcdep.2014.04.029
更新日期：2014-08-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/j.drugalcdep.2014.03.003
更新日期：2014-06-01 00:00:00
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journal_title：Drug and alcohol dependence
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1999-04-01 00:00:00
abstract：:Safety monitoring is a critical element of clinical trials evaluating treatment for substance dependence, but is complicated by participants' high levels of medical and psychiatric comorbidity. This paper describes AEs reported in a large (N = 286), 29-week outpatient study of behavioral interventions for heroin and c...
journal_title：Drug and alcohol dependence
pub_type： 杂志文章
doi：10.1016/j.drugalcdep.2005.03.007
更新日期：2005-10-01 00:00:00
