Performance Contracting to Engage Publicy Funded Patients

Performance contracting has become a fixture in medicine but it is a relative newcomer to substance abuse treatment. In an effort to improve the transition to treatment rate for Detoxification patients, Delaware expanded performance contracting to its detoxification provider in FY 2008. In FY 2006, only 18.7% of Delaware's publicly funded detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In FY 2008, Delaware established financial contingencies to: 1) maintain 90% or greater detoxification occupancy, 2) make receipt of 10% of the facility's monthly financial reimbursement contingent on 25% of all patients entering treatment within 7 days and 3) provide $500 for every patient retained in continuing care. In FY 2008, under performance contract conditions, the detoxification provider initiated several procedural changes. Under the FY 2008 performance contract, the detoxification provider: 1) maintained the 90% occupancy requirement for eleven months, 2) achieved the 25% treatment entry target for patients for seven months and 3) witnessed just 8% (27/337) of detoxification completions having met the target length of stay criterion in continuing care (outpatient or residential treatment). Results were attained even as the patient population reported significantly higher rates of homelessness and mental illness over FY 2006. Contrary to expectations, the number of patients with three or more (3+) detoxifications in FY 2008 nearly tripled over 3+ patients in FY 2006.