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Eric Goplerud, Ph.D. APHA Annual Conference December 12, 2005 4:30-5:30

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, 2005 4:30-5:30. The Annual Costs of Alcohol Problems.

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Eric Goplerud, Ph.D. APHA Annual Conference December 12, 2005 4:30-5:30

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  1. 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, 2005 4:30-5:30

  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

  4. 2005 eValue8 Health Plans

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

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

  7. Identification Rates for Other Health Conditions 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 35 - 40 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

  16. Eric Goplerud, Ph.D., Director 2021 K Street NW, Suite 800 Washington, DC 20006 P: (202) 296-6922 F: (202) 296-0025 goplerud@gwu.edu www.ensuringsolutions.org

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