Using Cost Offset and Other Data to Impact Policy Antoinette Krupski, Ph.D. University of Washington at Harborview Medical Center Seattle, Washington

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Using Cost Offset and Other Data to Impact
PolicyAntoinette Krupski, Ph.D.University of
Washington at Harborview Medical CenterSeattle,
Washington

• Using Performance and Outcomes Measures to
  Improve TreatmentMarch 20-21, 2008Los Angeles,
  California

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Overview

• Types of data that have been used to impact
  policy in Washington State
• Data documenting extent of the problem
• Outcomes
• Policy impacts
• Where the data came from
• Lessons learnedwhat has been helpful?

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• Extent of Alcohol and
• Other Drug (AOD) Problems
• In
• Washington State

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Documenting Extent of the Problem

• Multiple populations
• General population
• Criminal justice populations
• Child welfare population
• Disabled/SSI, Medicaid recipients
• TANF recipients
• Burden of costs

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Extent of AOD Problems in Washington
StateGeneral Population

• 10.9 of adult household residents estimated to
  need treatment in 2005 (Mancuso, 2005)
• 13.6 of lower income adults were estimated to
  need treatment in 2005 (Mancuso, 2005)
• In 2006, about 31 of eligible lower-income
  adults who needed treatment actually received it
  (Albert, 2007)
• Among youth, about 32 of those eligible for
  treatment actually received it in 2006 (Albert,
  2007)

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Extent of AOD Problems in Washington
StateCriminal Justice Populations

• 70 booked arrestees (Seattle/Spokane) tested
  positive for alcohol and/or drugs (Kabel et al
  1996)
• 70 of adult prison inmates have an alcohol/drug
  problem (Department of Corrections)
• 82 of youth in state correctional facilities
  have a substance abuse problem (Juvenile
  Rehabilitation Administration, Department of
  Social and Health Services)

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Extent of AOD Problems in Washington StateChild
Welfare Populations

• 75 of parents of children in therapeutic foster
  care had documented substance abuse problems
  (OCAR, 1993)
• 66 of parents of children in foster care had
  documented substance abuse problems (OCAR 1993)

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Extent of AOD Problems in Washington StateOther
Welfare Populations

• 20 of disabled individuals on Medicaid (Blind,
  Disabled, GA-X) estimated to need alcohol/drug
  treatment (Mancuso et al 2005)
• 30 of individuals on GA-U estimated to need
  alcohol/drug treatment (Mancuso et al 2005)
• 13 of TANF recipients estimated to need
  treatment (Mancuso et al 2005)

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Economic Costs of Substance Abuse in Washington
State

• 5.21 billion for 2005
• Most costly categories
• Mortality 2 billion
• Crime 1.1 billion
• Morbidity 1 billion
• Medical care 791 million (Wickizer et al 2008)

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Some Consequences of AOD Abuse
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Study of Frequent Visitors to Emergency Rooms (ER)

• Study based on records for all Medicaid aged,
  blind, disabled clients (n130,274) eligible
  between 7/98-6/02
• Persons with AOD and mental health disorders
  identified from diagnoses in medical claims
• ER events also available in medical claims

Mancuso, Nordlund, Felver, 2004
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Two-Thirds of Frequent ER Visitors Have High
Rates of AOD Disorders
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Frequent Emergency Room Visitors Use High Volumes
of Pain Medication
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20 of Frequent ER Visitors Were Arrested in the
Last Year
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• Outcomes and Cost Offsets
• of
• AOD Treatment

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Study of All SSI Recipients in Washington State

• Study of all SSI recipients in WA State between
  7/97 and 12/01 (n128,913)
• 16 identified as having a need for AOD treatment
  (n20,952)
• 50 recd AOD treatment (n10,380)
• 50 did not (n10,572)
• Study compared costs of treated and untreated
  groups

Estee Nordlund, 2003
E
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AOD Treatment Resulted in Significant Medicaid
Savings
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Reduced Medical Costs Were 75 of the Overall
Cost Offset from AOD Treatment
-
ER
-
Other MAA Medical
Mental
Nursing
Health
Home
38
11
14
Per client per month

154

157

56

47
per client per month
GROSS OFFSET 414

AOD Treatment Cost 162

NET OFFSET
252
Nordlund, Mancuso, Felver, 2004
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AOD Treatment Leads to Reductions in Arrests

• 16 reduced likelihood of subsequent arrest for
  persons entering AOD treatment
• 34 reduced likelihood of subsequent felony
  conviction for those entering AOD treatment
• 43 reduced likelihood of subsequent arrest for
  persons completing AOD treatment

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Conclusion

• High cost of not funding alcohol/drug treatment
• Significant medical costs
• High ER use
• High rate of arrests convictions
• Treatment results in significant cost offsets and
  reduced arrests/convictions
• Funding treatment is a good investment in health
  care cost containment and public safety

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Policy Impacts

• Consistent budget increases from 1988 to present
• In 2005, a 30 budget increase
• Because of anticipated cost offsets, 32 million
  dollars for additional treatment for
  Medicaid-eligible adults and 16 million for
  criminal justice clients
• 6.7 million for additional treatment for youth
• Increase in residential treatment rates
• Most of the increase reflects shifts from other
  budgets (Medical Assistance, Criminal Justice)

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• Where the Data Came From

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Databases Where Information Resides

• Substance abuse database (TARGET)--publicly
  funded AOD treatment
• Medicaid Management Information System (MMIS)
• Medicaid-paid medical use/costs
• Some MH treatment/costs
• State Patrolarrests

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How Confidentiality Is Protected

• Follow 42CFR Part 2 for all data sharing
• All identified records kept in secure location
• Identified records cannot be re-disclosed except
  to the program that provided it
• Small number of qualified staff have access to
  identified records they sign confidentiality
  oaths
• Identifiers removed from analytic data files as
  soon as possible

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Other Confidentiality Safeguards

• Obtain entire data set from data-sharing partner
• Embed AOD client identifiers in larger subset of
  identifiers

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• What Was Helpful?

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Maintaining Collaborative Relationships with
Data-Sharing Partners

• Sharing findings with data-sharing partners prior
  to dissemination
• Conducting analyses of interest to data-sharing
  partners

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Collaborations with Research Community

• Research position within the division
• Maintaining a committee of substance abuse
  researchers
• Write grants on topics of mutual interest
• Publish papers in peer-reviewed journals
• Provide input to divisions research efforts
• Support responses to legislative requests

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Lessons Learned

• High quality data and analysis essential
• Publication in peer-review journals adds
  credibility
• Data are not enough
• Policy impacts take time
• Outcomes are not free!

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• Thank you!

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Contact Information

• Toni Krupski, PhD
• Dept of Psychiatry and Behavioral Sciences
• University of Washington at Harborview Medical
  Center
• Seattle, Washington
• krupski_at_u.washington.edu
• 206.897.4215