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Monitoring Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

UPMC Health Plan Behavioral Health Services, together with UPMC Health Plan, monitors the rates at which members with alcohol or other drug dependence initiate and engage in treatment for these disorders. Participating in treatment is important to successful recovery.

To monitor these rates, we use a standardized national methodology contained in the Health Plan Employer Data and Information Set (HEDIS). Treatment initiation is defined as the percentage of adults diagnosed with alcohol or other drug dependence who begin treatment either through:

• An inpatient drug or alcohol admission
• An outpatient drug and alcohol program and any other drug and alcohol service within 14 days

Treatment engagement is defined as the percentage of members who receive two additional drug or alcohol services within 30 days of initiating treatment. Rates for Initiation and Engagement of Alcohol and Other Drug Dependence Treatment are as follows:

Our 2004 calendar year rate for initiation is much higher than the national HEDIS average of 45.94% as well as much higher than the 90th national percentile of 56.76%. Our 2004 rate for engagement is also much higher than the national average of 15.46% and the 90th national percentile at 26.32%.

Barriers to members starting and engaging in substance abuse treatment may include:

• Member resistance to drug and alcohol treatment
• Fear of the stigma of receiving drug and alcohol services
• Lack of community supports
• Lack of coordination of care between physical and behavioral health clinicians

UPMC Health Plan Behavioral Health Services and UPMC Health Plan have implemented the following interventions to improve the rates of initiation and engagement of alcohol and other drug dependence treatment:

• Adoption of the National Institute on Drug Abuse Principles of Drug Addiction Treatment: A Research-Based Guide treatment guideline for the UPMC Health Plan Behavioral Health Services network. This guideline was approved by the Quality and Care Management Committee on April 18, 2005
• Posting of educational resources related to alcohol and drug disorders and treatment on Community Care's website for both practitioners and members
• Distribution of a Behavioral Health Resource Guide to practitioners, which included self-help and support groups available to members. This guide is also available to members and practitioners on Community Care's website, as well as UPMC Health Plan's website
• Screening for co-occurring disorders by Care Managers during utilization management reviews
• Posting and monitoring of substance abuse treatment guidelines that include information about alcohol and drug screening and treatment interventions for primary care physicians on the UPMC Health Plan website.

UPMC Health Plan Behavioral Health Services and UPMC Health Plan will continue to monitor initiation and engagement in drug and alcohol treatment and develop additional interventions, as needed, to improve these rates.

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