Performance-Based Contracting Within a State Substance Abuse Treatment System: A Preliminary Exploration of Differences in Client Access and Client Outcomes

To explore whether the implementation of performance-based contracting (PBC) within the State of Maine’s substance abuse treatment
system resulted in improved performance, one descriptive and two empirical analyses were conducted. The first analysis examined
utilization and payment structure. The second study was designed to examine whether timeliness of access to outpatient (OP)
and intensive outpatient (IOP) substance abuse assessments and treatment, measures that only became available after the implementation
of PBC, differed between PBC and non-PBC agencies in the year following implementation of PBC. Using treatment admission records
from the state treatment data system (N = 9,128), logistic regression models run using generalized equation estimation techniques found no significant difference
between PBC agencies and other agencies on timeliness of access to assessments or treatment, for both OP and IOP services.
The third analysis, conducted using discharge data from the years prior to and after the implementation of performance-based
contracting (N = 6,740) for those agencies that became a part of the performance-based contracting system, was designed to assess differences
in level of participation, retention, and completion of treatment. Regression models suggest that performance on OP client
engagement and retention measures was significantly poorer the year after the implementation of PBC, but that temporal rather
than a PBC effects were more significant. No differences were found between years for IOP level of participation or completion
of treatment measures.