Cleveland, OH—Researchers from the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University recently conducted an analysis of claims data for behavioral-health services in the State of Ohio and found that Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, helped save the state approximately $1.4 million in service costs for a group of 160 people diagnosed with a severe mental illness and a co-occurring substance use disorder. The people in this group were among the highest users of mental health and addiction services. The savings took place only one year after they started to receive IDDT services. This analysis is compelling, because it shows that IDDT can make an impact upon costs in a short amount of time.
The analysis of IDDT in Ohio was conducted by the CEBP—and its Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE)—in partnership with the Ohio Department of Mental Health and the Ohio Department of Alcohol and Drug Addiction Services.
This first analysis looked at those people who had the highest service utilization in the year before starting IDDT—160 people cost Ohio's treatment system over $5.7 million in the year before joining IDDT. Those same people cost just under $4.4 million in the first year on an IDDT team—a savings to the system of over $1.4 million for just those 160 individuals.
METHODS OF THE ANALYSIS
According to Deb Hrouda, MSSA, LISW-S, director of quality improvement at the CEBP and lead researcher of this evaluation project, the investigators examined claims data from the State of Ohio's Multi-Agency Community Services Information System (MACSIS) via the IDDT Affiliation Code, which is a field in the MACSIS database that enables service organizations, county boards, and state departments to tag and analyze information about consumers who have been affiliated with (receiving) IDDT services. The IDDT Affiliation Code identifies a person as a recipient of IDDT services along with his/her start- and end-dates. (For more information about MACSIS and the affiliation code, consult this free step-by-step booklet [click here].) ((DEAD LINK))
The research team studied the service utilization patterns of IDDT recipients, which included data for the following:
- Crisis intervention
- State hospital bed days (psychiatric hospitalization)
- Residential services (housing)
- Outpatient medical care (from psychiatrists and nurses)
- Group and individual community support (e.g., community support services (CPS)
- Group and individual counseling services
- Levels of Service Utilization
At the time of the analysis, 2,715 people had been identified in MACSIS as receiving IDDT from 25 different IDDT teams in community agencies throughout Ohio. Of the 2,715, a total of 1,122 had been on an IDDT team for at least twelve months. Researchers examined the claims data of this group for a specific time period of 12 months prior to the onset of IDDT services. They noticed three distinct levels of service utilization among these people:
- No utilization (e.g., as a result of being homeless, in jail, in prison, or not engaged in treatment)
- Low/ moderate utilization
- High utilization
- High Utilization: Pre & Post IDDT
The researchers then compared service utilization and costs for the 160 people in the "high utilization" group for two timeframes: one-year prior to the onset of their IDDT services and one year after the onset. MACSIS captures both the start-date and end-date of services for each consumer.
Below is a summary of the data for the high-utilization group:
- Pre = One year prior to onset of IDDT admission
- N = 160 people
- $5.7 million = total claims
- Post = One year after the onset of IDDT admission
- N = 160 people
- $4.4 million = total claims
For more detailed information, consult these resources from the evaluation project:
PowerPoint Slide #1 (PDF) / Service-Utilization Categories (click here) ((DEADLINK))
PowerPoint Slide #2 (PDF) / Average Cost Per Consumer, Pre- and Post-IDDT Services (click here) ((DEAD LINK))
POLICY & PRACTICE IMPLICATIONS
According to Hrouda, the major finding from this analysis—that IDDT produced a $1.4 million reduction in total behavioral-health claims (costs) in one year among those people who utilized the most services—has two important implications. First, the one-year timeframe is much sooner than expected, demonstrating that investments in IDDT may produce important impacts quickly. Second, the finding can also be used to inform policies and practices for establishing eligibility criteria.
"Individuals with the highest level of service utilization are definitely one target population that is eligible for IDDT," Hrouda says. "There are others as well."
According to Patrick E. Boyle, MSSA, LISW-S, LICDC, director of implementation services at the CEBP, service utilization is only one measure of the impact of IDDT upon people with co-occurring disorders. The CEBP continues to help community service agencies track clinical outcomes and indicators. The research team at the CEBP will be looking at other measures as well. They will also conduct additional analyses of the MACSIS affiliation-code data to see what might be learned about the experiences of people in the other groups of service utilization identified in the data (e.g., no utilization, low/moderate utilization). He anticipates that this information will contribute to the knowledge base that continues to inform the policies and practices that aim to improve the quality of life and other outcomes for residents in Ohio.
IMPORTANCE OF INTEGRATED TREATMENT
Ric Kruszynski, MSSA, LISW, LICDC, director of consultation and training for the CEBP's Ohio SAMI CCOE initiative, explains that IDDT is important, because it is designed to help some of Ohio's most vulnerable citizens, namely, those with severe mental illnesses—such as schizophrenia, schizoaffective disorder, and bipolar disorder—who also use alcohol or other drugs.
People with these severe co-occurring (or dual) disorders are among the most vulnerable to unemployment, homelessness, poverty, chronic health problems, frequent hospitalization, and arrest and incarceration, among other negative life outcomes. IDDT eliminates potential gaps in service by combining mental health and addiction services. It helps people with co-occurring disorders address both at the same time—in the same service organization with the same team of treatment providers.
The CEBP at Case Western Reserve provides technical assistance (consulting, training, and evaluation services) for implementation of IDDT throughout the state via its Ohio SAMI CCOE initiative. The CEBP provides technical assistance to the state departments of mental health and addiction services, to all of the state-supported psychiatric hospitals, and to over 60 community mental-health and addiction-services agencies.
Kruszynski encourages policymakers and administrators of service organizations interested in IDDT and other strategies that address co-occurring disorders to contact the CEBP:
IDDT & THE NATIONAL SCENE
Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, was developed and continues to be studied by researchers at the Psychiatric Research Center of Dartmouth Medical School in Lebanon, New Hampshire. The researchers include Robert E. Drake, MD, PhD, and Gary Bond, PhD, and their colleagues.
The Dartmouth PRC has provided leadership for national implementation of IDDT via the Substance Abuse and Mental Health Services Administration. The State of Ohio and the Center for Evidence-Based Practices at Case Western Reserve University—through its SAMI CCOE initiative—have participated and continue to participate in these national initiatives, making significant contributions to the advancement of the model.
Listen to and read about the CEBP's interviews with Dr. Drake (click here) and Dr. Bond (click here). ((LINK TO STORIES))
The Center for Evidence-Based Practices (CEBP) at Case Western Reserve University is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case School of Medicine. The Ohio SAMI Coordinating Center of Excellence (CCOE) and Ohio Supported Employment CCOE are both initiatives of the Center for EBPs and are a part of the State of Ohio's CCOEs initiative.
- Lenore A. Kola, PhD, Associate Professor of Social Work, Mandel School of Applied Social Sciences, Case Western Reserve University
- Robert J. Ronis, MD, MPH, Douglas Danford Bond Professor and Chair, Department of Psychiatry, Case School of Medicine
- The Center for EBPs works in collaboration with and is supported by the following:
- Ohio Department of Mental Health
- Ohio Department of Alcohol and Drug Addiction Services
- Ohio Rehabilitation Services Commission