PERFORMANCE CONTRACTING FOR SUBSTANCE-ABUSE TREATMENT

Objective. To describe an innovation in performance contracting for su bstance abuse services in the State of Maine and examine da:a on measu red performance by providers before and after the innovation. Data Sou rces and Collection. From the Maine Addiction Treatment System (MATS), an admission and discharge data set collected by the Maine Office of Substance Abuse (OSA). The MATS data for this study include informatio n on clients of programs receiving public funding from October 1, 1989 through June 30, 1994. Additional data are drawn from the contracts b etween the state and providers, and from service delivery reports subm itted to QSA. Study Design. Client-level performance measures were cal culated directly from MATS using OSA's formulas and standards, and the n aggregated to the-treatment program level. Multivariate regression a nalysis was done for each performance indicator as a dependent variabl e with performance contracting, time, extent of state funding, and pro vider characteristics as independent variables. Principal Findings. Pe rformance contracting is positively related to better performance for effectiveness indicators overall. Individual effectiveness indicators that showed improvement include drug use indicators (abstinence and re duction in use) and social functioning indicators. In addition, perfor mance contracting is associated with an increase in efficiency perform ance, defined as delivery of the contracted amount of service, for age ncies that depend heavily on OSA for funding. Finally, performance con tracting appears unrelated to the special populations indicators that measure services to target populations that OSA considers harder to tr eat. Conclusions. There is tentative evidence of a relationship betwee n provider performance and the introduction of performance contracting . More definite conclusions await more detailed analyses of client-lev el data.