JOINT EFFORT TO STUDY DRUG ABUSE CARE

Researchers at Harvard and Brandeis Universities were awarded a $1.3
million grant from the National Institute of Drug Abuse last week to
undertake a five-year study into the most medically and financially
effective ways to combat substance abuse problems through managed care.

"The point of the grant is to look at how various kinds of
organizations and financing arrangements affect the quality and cost
of substance abuse care...to help real world programs do a better job
with the money they put into substance abuse programs and to help
[them] redesign how they do things," said Harvard Medical School (HMS)
Morris Professor of Health Economics Richard G. Frank, who will be a
co-principal investigator on the project. "Hopefully it can really
make a difference."

Another principal investigator, Constance Horgan, who is director of
the Center for Behavioral Health at Brandeis University's Heller
School, was not available for comment. Horgan has worked on numerous
projects examining how health services are provided in the changing
managed care environment, according to the Heller School website.

Brandeis and Harvard's health departments have worked on similar
projects since the mid-90s, during which they also received a
significant grant.

The research project is divided into four main areas. One focus of the
study is a program run by the state of Connecticut that "rewards
medical providers for doing a good job with Medicaid beneficiaries who
abuse substances," Frank said. The researchers will try to determine
whether such monetary incentives are effective in encouraging
providers to produce better results in substance abuse recoveries.

A second area of inquiry is the way in which treatment and welfare
reform interact for people with substance abuse problems.

"Some states really integrate welfare informationwhile other states
say you can't have treatment until you get a job," Frank said. "We are
seeing how well people do under those two different
circumstances."

HMS Professor of Health Economics Thomas G. McGuire, another
co-investigator of the study, said that welfare reform is "to some
degree a one-size-fits-all policy and we are trying to figure out how
this aggregate policy suits the most disadvantaged."

A third aspect of the study is to look at private managed care
companies individually and to examine how costs and outcomes differ
when Employee Assistance Programs (EAPs) are integrated with managed
care.

"[EAPs] typically work with management and teach them what the
workplace symptoms of substance abuse are and to sensitize supervisors
and managers to them and to facilitate those employees getting
help...[while managed care tries] to arrange for substance abuse care
in a way that reduces the cost and increases efficiency," said William
C. Barron, a clinician with Harvard's EAP.

"The hypothesis is that when these two are linked, you might get
better outcomes in terms of costs," Frank said. "If we learn that
integrating them into one thing that does both as opposed to keeping
them separate, then perhaps they'll redesign what they offer
employers, so for same amount of money they can offer more."

Data for the EAP study will come from Managed Health Network, Inc. a
mental and behavioral health services company.

The researchers will also study whether equal coverage of substance
abuse treatment, compared with coverage of more standard treatments,
is affordable or practical.

"I think there is interest in employer and employee groups in dealing
with substance abuse, but the problem is that they're not in the
position to finance research and are not sure what right thing for
their employees is," McGuire said.