Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs

• Published in: The journal of behavioral health services & research Vol. 44; no. 1; pp. 102 - 112
• Main Authors: Paltzer, Jason, Brown, Richard L., Burns, Marguerite, Moberg, D. Paul, Mullahy, John, Sethi, Ajay K., Weimer, David
• Format: Journal Article
• Language: English
• Published: New York Springer US 2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Alcohol; Beneficiaries; Brief interventions; Clinics; Community and Environmental Psychology; Cost analysis; Cost control; Drug abuse; Drug use; Emergency medical care; Emergency medical services; Emergency services; Female; Government programs; Health care; Health care expenditures; Health care industry; Health care policy; Health education; Health Informatics; Health Promotion and Disease Prevention; Health Psychology; Health sciences; Health services; Health services utilization; Help seeking behavior; Hospitalization; Humans; Intervention; Interviews as Topic; Lifestyles; Male; Medicaid; Medical screening; Medical treatment; Medicare; Medicine; Medicine & Public Health; Mental health; Mental health care; Middle Aged; Morbidity; Morbidity-Mortality; Mortality; Paraprofessionals; Patient Acceptance of Health Care; Patient Protection & Affordable Care Act 2010-US; Patients; Population; Population studies; Primary care; Psychiatry; Public Health; Qualitative Research; Referral and Consultation; Reimbursement; Savings; Screening; Screens; Studies; Substance abuse; Substance abuse treatment; Substance use; Substance-Related Disorders - diagnosis; Substance-Related Disorders - therapy; Task forces; United States; Utilization; Wisconsin; Young Adult; United States > US; Wisconsin; Healthcare Utilization; Average Treatment Effect; Medicaid Patient; Propensity Score Match; Supplemental Security Income
• ISSN: 1094-3412; 1556-3308
• DOI: 10.1007/s11414-016-9510-2

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.