Thursday, September 6, 2012

Continuing Care Produces Reduces Costs for Substance Use Patients

Persuasive Research for a Chronic Care Model for Some People with SUD
There are two fascinating research reports that recently came out of the group anchored and founded by Connie Weisner, a very productive and insightful scientist conducting health services research at Kaiser-Permanente in San Francisco. In addition to being a first-class scientist, Dr. Weisner is a genuinely good person and a great mentor who has built an extremely productive group. Jennifer Mertens is one of her protégés who has emerged as a first-class scientist in her own right.
The first of these two articles examined the healthcare costs of a group of people who presented for substance use disorder (SUD) treatment at a Kaiser facility. First-authored by Sujaya Parthasarathy, another up-and-coming health services researcher, this study followed SUD patients and compared their health care costs over the ensuing 9 years, compared to a matched group of non-SUD patients (Parthasarathy, Chi et al. 2012). The aim of the study was to examine the association between elements of continuing care over that period and health care costs. Continuing care was defined as ideally having three components: an annual primary care visit plus the availability and use of either SUD or psychiatric services as needed. They hypothesized that people with more components of continuing care would have lower healthcare costs. They had previously shown that having more elements of continuing care was associated with greater rates of abstinence.
What did they find? Having all three elements of continuing care available and used was associated with lower health care costs over a 9 year period, compared with those receiving fewer components. The SUD patients who did not receive continuing care had inpatients costs of $66 per member per month (that’s a lot), while those receiving continuing care did not differ from non-SUD controls.
This study is observational. That is, it followed people over time and then examined correlations, or associations among different variables. There is a principle in research, which is, “Correlation does not imply causation.” That is, one cannot determine what causes what, merely that two variables, such as receiving continuing care and abstinence, tend to occur together more than would be expected by chance. So, it cannot be concluded, for example, that providing continuing care caused improved outcomes and reduced healthcare costs. Or whether patients who were already doing well (for whatever reason) caused more continuing care by making better use of appropriate healthcare services.
Nevertheless, I believe that, combined with other studies, there is a powerful argument to be made that SUD services should include all three components when appropriate: primary care, SUD treatment services and mental health treatment, and that these services should be available on a continuing basis for as long as needed. This is, after all, how we treat virtually every other disease, from asthma to depression to arthritis. It also makes sense to make every effort to make them available in as seamless and integrated a fashion as possible.

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