High Performing Addiction Treatment Centers: A Frontier Analysis in Maryland

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High Performing Addiction Treatment Centers A
Frontier Analysis in Maryland

• Rafael A. Corredoira
• Robert H. Smith School of Business
• University of Maryland CP
• Jon Chilingerian
• Brandeis University
• October 2008

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Performance Study of Addiction Treatment

• Treatment outcomes of addiction clinic is a major
  social and public policy issue
• 161 addiction treatment clinics and 30,660
  patients categorized into 3 severity levels in
  Maryland (year 2005)
• Measures of clinic effectiveness in treating
  addiction.
• quantity of clients completing the program and,
• quantity of clients not using drugs at discharge

• Software (1) General DEA (Excel Solver)

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Performance Model for Addiction Treatment
Centers
Quantity of clients treated
Clinical outcomes
Quantity of patients completing treatment
Low Severity Clients
Treatment therapies and care programs
Moderate Severity Clients
Quantity of patients not using drugs at discharge
High severity clients
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How DEA Works
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Performance Frontier for Addiction Treatment
Centers
Completion and No Use Rates
e Target completion/no use rate for C8
Performance Frontier
C9
C1
e
C4
C2
F
C3
C8
C7
C5
C6
C10
Quantity of Low-Moderate-High Severity Clients
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Findings

• 24 of 161addiction treatment centers were on the
  best practice frontier scoring 100 effective
• The mean performance score for the 161 was 70
• This means that there is a potential improvement
  of _at_ 30
• 26 centers were less than 50 percent effective
• The least effective center was only 24 as
  effective as the best and could have used
  improved their performance by 76

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Relative Performance Scores n161
CENTER SCORE
CENTER SCORE
CENTER SCORE
CENTER SCORE
C101008 100.00 C101024 100.00 C101082
92.96 C101162 52.56 C101180 67.75 C101224
38.87 C101255 75.11 C101264 79.60 C101286
37.74 C101287 26.15 C101299 60.96 C101314
88.77 C101327 56.11 C101344
81.80 C101347 100.00 C101349 100.00 C101382
70.56 C101383 58.07 C101384 44.16 C101412
73.18 C101421 77.79 C101453 72.56 C101495
83.43 C101545 72.33 C101636 70.61
C101669 51.13 C101685 77.02 C101735
62.37 C101792 69.70 C101834 100.00 C101859
75.59 C101990 88.62 C102030 91.73 C102097
32.38 C102105 84.45 C102196 100.00 C102204
63.01 C102212 75.18 C102261
75.76 C102295 100.00 C102378
78.95 C102501 100.00 C102667 88.10 C102675
79.22 C102816 87.59 C102972
52.58 C103079 100.00 C103111 100.00 C103236 100
.00 C103251 98.35
C103434 70.05 C103533 76.26 C103608
54.51 C103616 77.06 C103707 100.00 C103715
54.48 C103731 72.87 C103780
84.80 C103798 100.00 C103889 29.21 C103947
80.16 C103962 100.00 C104028 65.49 C104044
62.32 C104085 100.00 C104150 48.14 C104200
87.36 C104242 90.40 C104564
71.76 C104721 100.00 C104796 100.00 C104804
73.53 C105025 100.00 C105041 100.00 C105181
95.79
C2 82.45 C43 100.00 C62 100.00 C121 100.00 C
281 100.00 C361 100.00 C461 84.99 C541
70.32 C621 26.55 C641 91.60 C702 100.00 C703
100.00 C704 98.68 C100059 40.92 C100091 100.
00 C100331 79.13 C100372 72.59 C100406
71.42 C100422 100.00 C100742 25.25 C100781
95.11 C100828 95.49 C100881 100.00 C101003
45.91 C101005 35.39
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Relative Performance Scores n161
CENTER SCORE
CENTER SCORE
CENTER SCORE
C105876 94.19 C105884 80.18 C105967 100.00 C
105983 81.38 C106023 100.00 C106064 100.00 C10
6163 100.00 C106288 57.99 C106494
85.22 C106601 95.60 C106619 60.72 C106825
82.93 C300014 84.90 C300030 56.47 C300329
80.23 C301293 67.26 C301301
38.03 C301400 100.00 C301780 60.44 C750325
65.06 C750382 73.25 C750390 86.45 C750408
70.62 C750424 84.08 C750473 100.00
C903783 84.38 C903817 89.79 C903874 100.00 C
903932 100.00 C904047 100.00 C904120
94.89 C904153 100.00 C904179 80.93 C904211
61.16 C904229 100.00 C904260 59.24
C750499 74.59 C750515 100.00 C750564
86.14 C750614 63.49 C900136
51.93 C900227 100.00 C900300 85.87 C900326
85.17 C900375 65.05 C900433 58.99 C900441
79.18 C901209 43.03 C901720 73.80 C901779
87.17 C901811 50.13 C901845 96.05 C902157
70.59 C902199 77.13 C902512 87.74 C902744
67.93 C902801 52.29 C902967 100.00 C903072
81.32 C903676 100.00 C903684 61.26
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Performance Distribution of Maryland Substance
Abuse Centers
31
27
24
22
22
12
10
8
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Performance Scores
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Performance Comparison of Two Addiction
Treatment Centers Best Practice vs Other
Quantity of clients treated
Clinical outcomes
287 patients completing treatment
58 Low Severity Clients
C62 (Score 100)
35 Moderate Severity Clients
213 patients not using drugs at discharge
196 High severity clients
Quantity of clients treated
Clinical outcomes
40 patients completing treatment
3 Low Severity Clients
C621 (Score 25)
37 Moderate Severity Clients
48 patients not using drugs at discharge
163 High severity clients
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Hypotheses

• H1 Volume of Patients ()
• H2 High Severity (-)
• H3 Clinic specializes on Severity Group ()
• H4 Clinic specializes on Level I treatment
  ()
• H5 Receive State Funding ()
• H6 Countys income per capita ()
• H7 Number of clinics per square mile (-)

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What happens if we focus on the average or the
limit?
t2
t1.1
t1
t1.0
t0
t0
Number of units
Number of units
ROA
ROA
Source Managing for consistency in franchises,
Anne Marie Knott, 2006
17
How consistency facilitates performance
analysis
Shock to industry
No. of units
Performance ?
Some units having trouble
No. of units
Performance ?
Control units
Units testing new protocol
No. of units
Value of experimental protocol
Performance ?
Source Managing for consistency in franchises,
Anne Marie Knott, 2006
18
Mechanisms are reinforcing
Initial Design
Good initial design eases training
Precise initial design highlights deviations
Training
Monitoring
Training ensures design Is understood
Deviations become Cues for redesign
Incentives
Monitoring ensures compliance with routine as
intended
CONSISTENCY WITH DESIGN
Incentives ensure compliance with routine as
understood
Source Managing for consistency in franchises,
Anne Marie Knott, 2006
19
How information is leveraged

• Monthly peer reports
• Each bank knows exactly its rank relative to
  other banks
• The worst bank must contact one of the best banks
  and learn from it how to improve

Source Managing for consistency in franchises,
Anne Marie Knott, 2006
20
What happens in the limit?
Number of units
ROA
Source Managing for consistency in franchises,
Anne Marie Knott, 2006