title: Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs.
abstract: Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a population-based sample of Medicaid patients 18-64 years receiving healthcare services from 33 clinics in Wisconsin. Substance use screens were completed by 7367 Medicaid beneficiaries, who were compared to 6751 randomly selected treatment-as-usual Medicaid patients. Compared to unscreened patients, those screened changed their utilization over the 24-month follow-up period by 0.143 outpatient days per member per month (PMPM) (p < 0.001), -0.036 inpatient days PMPM (p < 0.05), -0.001 inpatient admissions PMPM (non-significant), and -0.004 emergency department days PMPM (non-significant). The best estimate of net annual savings is $391 per Medicaid adult beneficiary (2014 dollars). SBIRT was associated with significantly greater outpatient visits and significant reductions in inpatient days among working-age Medicaid beneficiaries in Wisconsin.
authors.affiliation: Population Health Institute, Population Health Sciences Department, University of Wisconsin-Madison, 6622 S. 50th Ave, Phoenix, AZ, 85339, USA. jpaltzer@wisc.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Paltzer
authors.affiliation: Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm. 787, WARF Building, Madison, WI, 53726, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Brown
authors.affiliation: Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Court, Madison, WI, 53704, USA.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Burns
authors.affiliation: Population Health Institute, Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street 575-E WARF, Madison, WI, 53726, USA.
authors.forename: D Paul
authors.initials: DP
authors.lastname: Moberg
authors.affiliation: Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm 601, WARF Building, Madison, WI, 53726, USA.
authors.forename: John
authors.initials: J
authors.lastname: Mullahy
authors.affiliation: Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm 501 WARF Building, Madison, WI, 53726, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
authors.affiliation: LaFollette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI, 53706, USA.
authors.forename: David
authors.initials: D
authors.lastname: Weimer
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*; D014481:United States; D014922:Wisconsin; D055815:Young Adult