title: Clinical-based vs insurance-based recommendations for substance abuse treatment level.
abstract: An exploratory study of 250 patients was conducted at three treatment facilities in Western Pennsylvania, USA, to determine: 1) the extent of disagreement between clinical-based [using American Society of Addiction Medicine (ASAM) criteria] and insurance-based [using Managed Care Organization (MCO) criteria] recommendations for treatment levels, and 2) the extend of ASAM recommendations that become the actual treatment. Cross-tabulations showed: 1) ASAM and MCO recommendations were the same for 85% of the cases, and 2) ASAM recommendations became the actual treatment in 93% of the cases. The exceptionally high level of ASAM-MCO agreement suggests a convergence in ASAM and MCO criteria and a deference to ASAM criteria in practice.
authors.affiliation: Mid-Atlantic Addiction Training Institute, Indiana University of Pennsylvania 15705, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gondolf
authors.forename: K
authors.initials: K
authors.lastname: Coleman
authors.forename: S
authors.initials: S
authors.lastname: Roman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D000553:Ambulatory Care / Q000191:economics; D001291:Attitude of Health Personnel; D003363:Cost Control; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D010414:Pennsylvania; D016320:Substance Abuse Treatment Centers / Q000191:economics; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D016896:Treatment Outcome