Selection incentives in a XXXX system.

@entity1 @entity734 @entity2472
OBJECTIVE: To investigate whether a @entity2472 ( @entity2472 ) system provides incentives for nonprofit providers of @entity734 treatment to select less severe clients into treatment. DATA SOURCES: The Maine Addiction Treatment System (MATS) standardized admission and discharge data provided by the Maine Office @entity734 ( @entity734 ) for fiscal years 1991-1995, provides demographic, @entity734 , and social functional information on clients of programs receiving public funding. STUDY DESIGN: We focused on @entity734 clients (i.e., those @entity1 whose treatment cost was covered by the funding from @entity734 ) and Medicaid clients in outpatient programs. Clients were identified as being "most severe" or not. We compared the likelihood for @entity734 clients to be "most severe" before @entity2472 and after @entity2472 using Medicaid clients as the control. Multivariate regression analysis was employed to predict the marginal effect of @entity2472 on the probability of @entity734 clients being most severe after controlling for other factors. PRINCIPAL FINDINGS: The percentage of @entity734 outpatient clients classified as most severe users dropped by 7 percent (p < = 0.001) after the innovation of @entity2472 compared to the increase of 2 percent for Medicaid clients. The regression results also showed that @entity2472 had a significantly negative marginal effect on the probability of @entity734 clients being most severe. CONCLUSIONS: Performance-based contracting gave providers of @entity734 treatment financial incentives to treat less severe @entity734 clients in order to improve their performance outcomes. Fewer @entity734 clients with the greatest severity were treated in outpatient programs with the implementation of @entity2472 . These results suggest that regulators, or payers, should evaluate programs comprehensively taking this type of selection behavior into consideration.
