Table 2:
Design and evaluation of pay-for-outcomes initiatives in Maine and the UK
| Commons 1997 | Mason 2015 | |
|---|---|---|
| A. PROGRAM DESIGN | ||
| Setting | Maine public treatment system, USA | 8 pilot localities in England |
| Time period | 1989-94 | 2011-13 |
| Units receiving reward | Specialty SUD treatment programs | Specialty SUD treatment programs |
| Units paying reward | State substance abuse authority | “Drug Action Teams” that pay providers (“commissioning entities”) |
| What triggers reward | Program must exceed preset % of clients achieving the outcome | Varies by locality |
| Form of reward | Not explicit until 1994. Poor-performers had to meet state officials re how to improve. Some good performers were awarded additional federal block grant funds | Part of provider’s income was at risk for performance on outcomes, with the share varying across areas (from 5% to 100%). |
| Proportion of providers’ revenue at risk | Not reported; probably varied | Varied from 5% to 100%, depending on decision by each locality. Localities also chose how much weight to put on the different measures. |
| Risk adjustment | None. But many measures were computed as change from entry to discharge | Budgets were adjusted for client characteristics based on a specially developed model (the ‘complexity tool’) |
| B. EVALUATION | ||
| Unit of analysis | Program-quarter | Admission |
| Patient outcomes evaluated | % of the effectiveness standards that the program met, in quarter | % of all drug treatment episodes resulting in ‘Successful completion’, including being judged by a clinician to be free of dependency from the drug for which the individual was being treated, and in addition not using either heroin or crack cocaine |
| Period studied | 1989-1994 | 2010-2013 |
| Study design | Pre-post with no comparison group | Pre-post with comparison group |
| Experimental group | All publicly funded programs in Maine were subject to the P4P initiative | The 8 areas in England that successfully applied to take part in this pilot program |
| Comparison group | None – but the model tested whether P4P had a stronger effect when the payer’s share of volume was larger (dependence) | The other 140 localities in England |
| Papers reporting on evaluation | Commons et al., 1997 | Mason et al., 2015; Donmall et al., 2017 |
Source: adapted from information in Commons et al. 1997, Mason et al. 2015 and Donmall et al. 2017.