Research Objective: Opiate addiction is a chronic disease requiring long-term maintenance treatment. This paper examines the impact of managed care and other factors contributing to retention in publicly funded methadone treatment in Oregon and Washington.
Study Design: This study uses statewide treatment databases and Medicaid eligibility files for 1992 through 1998. This seven-year period covers a dramatic expansion of eligibility in Oregon and the transition to managed care under the Oregon Health Plan. Reimbursement for services in Washington remained fee-for-service during this period.
Population: Medicaid-eligible adults presenting for publicly-funded substance abuse treatment in Oregon and Washington with opiates as the primary drug.
Findings: Retention in Oregon increased dramatically after the integration of substance abuse treatment into the Oregon Health Plan, although changes in provider practice appear to account for much of the increase. In contrast, retention in Washington was low since structural limitations prompted providers to administratively discharge about 60% of the patients for rule violations. Logistic regression was used to examine the relative contributions of various factors after controlling for predisposing, enabling, and need characteristics of the client.
Conclusions: Managed care organizations treated opiate addiction as a chronic disease, permitting changes in provider practices to dramatically increase retention. Where financial and structural barriers to methadone maintenance therapy have led to poor retention, new strategies are needed to expand access and improve retention.
Learning Objectives: Participants will be able to list the primary factors promoting retention in two states
Keywords: Substance Abuse Treatment, Methadone Maintenance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.