Impact of Purchaser Attention to Quality Alcohol Screening and Treatment in Commercial-Sector Health Plans: The NBCH eValue8 Process Eric Goplerud, Ph.D. APHA Annual Conference December 12, :30-5:30

2 The Annual Costs of Alcohol Problems 33 million work days lost costing more than $4 billion  80% of people with alcohol problems work or are family members of workers $36 billion in additional health care costs  Nearly $30 billion to treat the illnesses and injuries caused by alcohol use Sources: Ensuring Solutions’ analysis of 2002 National Survey on Drug Use and Health; Bureau of Labor Statistics; Alcohol Cost Calculator for Business

3 About eValue8 Nation-wide health plan evaluation process – developed by business for business Promotes continuous quality improvement and value-based purchasing Collects annual information on health plan practices and performance  64 health plans in 24 states covering 10 million lives  Data still to be analyzed from ~235 more health plans

eValue8 Health Plans

5 Estimated Percentage of Plan Members with an Alcohol Problem Recent estimates suggest that almost 8% of the US population has an alcohol problem 92% 8%

6 How Many Get Identified? <1% of plan members are diagnosed with alcohol problems.

7 I dentification Rates for Other Health Conditions Alcohol8% Depression40% Diabetes65% Hypertension70% What percentage of affected individuals are identified?

8 Follow-up Care for Members Identified with an Alcohol Problem

9 Members In Need Don’t Get the Recommended Treatment Members identified with a serious alcohol problem who receive any additional services within 14 days: 45% Members identified with a serious alcohol problem who receive three or more services within 30 days: 16%

10 Using Clinical Guidelines Authoritative Sources of Guidelines for the Screening and Treatment of Alcohol Use Disorders:  National Institute on Alcohol Abuse and Alcoholism  American Psychiatric Association  World Health Organization  Veterans Administration/Dept of Defense Only 50% of plans recommend that primary care providers use any of these guidelines.

11 Quality Treatment for Health Conditions

12 Here is the Problem:

13 How Plans Can Improve Teach members about hazardous drinking and what to do about alcohol problems. Require providers to use validated screening and treatment guidelines. Follow-up to ensure that members get treatment.

14 What business can do: Set expectations Inspect performance Use purchasing muscle National Business Coalition on Health  More 70 business coalitions with 7,000 employer members nationwide employing million people eValue8:  Uniform, annual assessment of the quality of alcohol care provided by health plans

15 Ensuring Solutions’ 2005 eValue8 behavioral health technical assistance: ensuringsolutions.org/pages/nbch

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Eric Goplerud, Ph.D., Director 2021 K Street NW, Suite 800 Washington, DC P: (202) F: (202)