house special committee on drug and alcohol abuse peter f. luongo, ph.d. october 2, 2007

House Special CommitteeOn Drug and Alcohol Abuse

Peter F. Luongo, Ph.D.October 2, 2007

Treatment Effectiveness

Alcohol and Drug dependent people who participate in drug treatment

Decrease substance use Decrease criminal activity Increase employment Improve their social and intrapersonal functioning Improve their physical health

Drug use and criminal activity ⇓⇓ for virtually all who enter treatment results the longer they stay in treatment.

Statewide Maryland Automated Record Tracking (SMART)

SMART is a full electronic clinical record (EHR) All funded treatment providers report data online

SMART addresses key EHR concerns: Admission, treatment encounters and discharge Privacy, Practitioner control, Administrative oversight Interoperability = shares information through XML

Additional Modules eCourt Contract Monitoring and Billing

Under development

Stand Alone Data Analyzer – December 2007 Real time access to data

Providers Jurisdiction decision makers State oversight (ADAA)

Automated Drug Testing – January 2008 Additional Clinical Assessments and

Screening Homicide and suicide lethality assessments HIV and TB risk assessments Many Others

Treatment Funding

2003 2007 % change

Appropriation $119,219,304 $126,447,179 6%

Individuals Treated* 45,722 52,306** 14%

Cost per Individual $2,607 $2,417 (7%)

FY 2003 – FY 2007

*Unduplicated individuals treated **Estimate based on 10 month data

Outpatient Adult Community Treatment

2003 2007 % change

Completed Treatment 37% 43% 16%

LOS ≥ 90 days 56% 59% 5%

Reduction in Substance Users 10% 33% 230%

Increase in Employment 10% 13% 30%

Selected OutcomesFY 2003 – FY 2007

Level III.1 Residential Treatment*

Selected OutcomesFY 2003 – FY 2007

2003 2007 % change

Completed Treatment 36% 42% 16%

LOS ≥ 90 days 54% 56% 4%

Reduction in Substance Users 0% 34% -

* Variable length of stay moderate intensity

FY 2006 ADAA-Funded Data and National Outcome Measures (NOMS) Data for Reporting States in 2004

Abstinent from Alcohol

Maryland 35 States

0

10

20

30

40

50

60

70

80

90

62.7

43.5

83.5

62.5

Admission Discharge

+33.1% +44.0%

FY 2006 ADAA-Funded Data and National Outcome Measures (NOMS) Data for Reporting States in 2004

Abstinent from Drugs

Maryland 34 States

0

10

20

30

40

50

60

70

80

44.534.5

71.5

56.2

Admission Discharge

+60.7% +62.9%

FY 2006 ADAA-Funded Data and National Outcome Measures (NOMS) Data for Reporting States in 2004

Employment

Maryland 38 States

0

5

10

15

20

25

30

35

40

33 30.7

39.134

Admission Discharge

+18.5% +10.8%

FY 2006 ADAA-Funded Data and National Outcome Measures (NOMS) Data for Reporting States in 2004

Arrested During Prior 30 Days

Maryland 34 States

0

5

10

15

20

25

30

35

40

8.8

37.1

2.4

11

Admission Discharge

-72.7% -70.4%

FY 2006 ADAA-Funded Data and National Outcome Measures (NOMS) Data for Reporting States in 2004

Homelessness

Maryland 34 States

0

1

2

3

4

5

6

7

8

9

8.57.5

4.55.4

Admission Discharge

-47.1% -28.0%

Summary Table

Treatment Awards Utilizing Performance Compensation

TreatmentCategory

Total Award

Amount of GrantFunding subject to

PerformanceCompensation

% PerformanceCompensation

Residential $ 41,207,873 $ 21,431,628 52%

Non-Residential $ 73,029,601 $ 24,819,233 34%

$114,237,474 $ 46,250,861 40%

Pay for Performance Pilot

Pilot based on:January – April 2007Data from Outpatient Programs – excluding:

AdolescentsJail-based population

Data in the system as of July 1, 2007

Performance Standards

>65% retained at least 90 days >50% successful completion

Both standards = 100% performance payment

One standard = 50% performance payment

Pay for Performance Incentive BreakdownCounty Discharges LOS >= 90 Complete

Jurisdictional Category A 1-2 Outpatient ClinicsCaroline 91 68.1% 52.7%Cecil 132 68.2% 37.1%Charles 273 72.9% 58.2%Dorchester 26 50.0% 34.6%Frederick 117 49.6% 32.5%Garrett 80 36.3% 28.8%Kent 92 54.3% 43.5%Queen Anne's 88 61.4% 47.7%Talbot 84 60.7% 53.6%Wicomico 126 61.9% 38.9%

Jurisdictional Category B 3-6 Outpatient ClinicsAllegany 171 54.4% 42.7%Carroll 139 66.9% 54.7%Harford 89 51.7% 38.2%Howard 63 57.1% 27.0%Montgomery 352 67.9% 45.5%Somerset 80 73.8% 50.0%St. Mary's 89 78.7% 65.2%Washington 214 74.3% 57.5%Worcester 153 51.6% 42.5%

Jurisdictional Category C 7+ Outpatient ClinicsAnne Arundel 579 63.6% 43.0%Baltimore County 406 63.3% 51.2%Prince George's 249 55.0% 41.8%Baltimore City 1043 49.6% 31.2%Statewide 36 55.6% 30.6%

Pay for Performance Incentive Breakdown

Full Incentive - 100% of Standards Met

County Juris. Cat. Discharges LOS >= 90 Complete

Caroline A 91 68.1% 52.7%

Charles A 273 72.9% 58.2%

Carroll B 139 66.9% 54.7%

Somerset B 80 73.8% 50.0%

St. Mary's B 89 78.7% 65.2%

Washington B 214 74.3% 57.5%

Partial Incentive - 50% of Standards Met

County Juris. Cat. Discharges LOS >= 90 Complete

Cecil A 132 68.2% 37.1%

Talbot A 84 60.7% 53.6%

Montgomery B 352 67.9% 45.5%

Baltimore Co. C 406 63.3% 51.2%

Jurisdiction Annual Incentive Prorated (4months)

A $15,000 $5,000

B $20,000 $6,667

C $30,000 $10,000

Full Incentive - 100% of Standards Met

County Jurisdiction Category Prorated

Caroline A $5,000

Charles A $5,000

Carroll B $6,667

Somerset B $6,667

St. Mary's B $6,667

Washington B $6,667

Partial Incentive - 50% of Standards Met

County Jurisdiction Category Prorated

Cecil A $2,500

Talbot A $2,500

Montgomery B $3,334

Baltimore County C $5,000

Financial IncentiveFor the initial year, a prorated amount is assigned to each classification. The following

table shows both the annualized and the prorated figures.

Method of Allocation

Method of AllocationPercent

of Total Award

Historic 45%

Earmarks 28%

Competitive 6%

Formula 21%

Total 100%

Central Region

Jurisdiction 2005 2006 2007

Baltimore City $47,241,235 $47,158,994 $48,720,080

Baltimore County $6,623,455 $7,435,398 $7,799,615

Harford County $2,084,304 $2,095,246 $2,386,649

Howard County $1,775,466 $1,780,466 $1,924,057

Total Regional Awards $57,724,460 $58,470,104 $60,830,401

Total Awards $123,232,702 $124,638,995 $130,782,647

Eastern Shore Region

Jurisdiction 2005 2006 2007

Cecil County $1,395,736 $1,400,736 $1,530,147

Dorchester County $1,323,836 $1,323,836 $1,428,273

Caroline County $633,774 $633,774 $718,891

Kent County $1,017,613 $1,017,613 $1,077,963

Queen Anne's County $789,650 $821,576 $881,194

Somerset County $1,077,933 $1,077,933 $1,109,440

Talbot County $941,422 $941,422 $968,916

Wicomico County $2,189,504 $2,228,034 $2,350,539

Worcester County $3,057,225 $3,226,325 $3,380,054

Total Regional Awards $12,426,693 $12,671,249 $13,445,417

Total Awards $123,232,702 $124,638,995 $130,782,647

Southern Region

Jurisdiction 2005 2006 2007

Anne Arundel County $4,821,491 $5,171,491 $5,415,712

Calvert County $1,120,131 $1,162,131 $1,203,021

Charles County $2,262,221 $2,304,802 $2,474,993

Prince George's County $10,806,803 $11,335,622 $11,628,634

St. Mary's County $2,798,750 $2,922,782 $3,118,274

Total Regional Awards $21,809,396 $22,896,828 $23,840,634

Total Awards $123,232,702 $124,638,995 $130,782,647

Western Region

Jurisdiction 2005 2006 2007

Allegany County $2,082,266 $2,362,756 $2,428,723

Carroll County $1,746,151 $1,752,756 $1,824,306

Frederick County $2,570,355 $2,596,089 $2,745,139

Garrett County $1,080,620 $1,087,120 $1,118,015

Montgomery County $4,961,899 $5,036,312 $5,265,177

Washington County $3,867,216 $3,867,216 $4,033,438

Total Regional Awards $16,308,507 $16,702,249 $17,414,798

Total Awards $123,232,702 $124,638,995 $130,782,647