In 2003, health plan executive Alex Braitman took decisive action that may dramatically improve patients' lives while effecting substantial savings for their employers. As director of behavioral health for Indiana's M•PLAN, Mr. Braitman, along with his company's psychiatric medical director, established clear guidelines for the treatment of M•PLAN's beneficiaries with alcohol problems. Mr. Braitman and other managed care executives were spurred to action by a consensus forged by businesses, health plans and government and clinical experts on the standards of alcohol treatment.

M•PLAN's health networks serve 170,000 beneficiaries. As more than 7 percent of American adults suffer from alcohol problems, Mr. Braitman and the companies who offer M•PLAN to their employees can reasonably expect that his action will help thousands. The efforts by M•PLAN and other health plans to implement alcohol practice standards show that when employers press their plans to improve the quality and accessibility of alcohol care, insurers respond.

Reducing Confusion

At the request of business leaders, the medical directors of some of the country's largest managed behavioral health organizations met with employers, treatment experts and federal officials to standardize the components of quality care for people with alcohol problems. The National Business Coalition on Health convened a group to identify key components of quality alcohol treatment based on existing scientifically grounded guidelines. The resulting practice standards are gaining wide acceptance, focusing the attention of purchasers, clinicians and consumers on enhancing the quality of care. Within weeks of the meeting, plans in Michigan, Indiana, Ohio and elsewhere initiated steps to utilize the committee's standards.

Managing Health Vendors

The practice standards provide a tool for businesses to evaluate their current health plans and to guide contracting for future services. They can be used to compare plans when making contractual decisions and negotiating rates, fees and services. The standards also can help companies hold their health plans accountable for providing the highest quality of care.

The New Alcohol Treatment Practice Standards

Some critical steps within the guidelines:

Screening

A standardized screening tool should be used to identify individuals at high risk of alcohol problems.

Diagnosis/Assessment

Based on screening results, some individuals should undergo further assessment for possible diagnosis of an alcohol use disorder.

To learn more about screening, see the Ensuring Solutions resource Alcohol Screening: A Quick First Step to Reduce Problem Drinking.

Triage

People identified by the assessment as at risk should receive brief intervention – a series of short counseling sessions – or a referral to a behavioral health specialist. (Alternatively, the primary care provider could consult with a specialist, guided by the standards.) For more on brief intervention, see Brief Intervention: Cost Effective Help for Problem Drinkers.

Education

Plans should provide consumer education resources. They should facilitate collaborative discussion by health practitioners of the importance of treatment as well as of treatment options, including the use of medication. Plans should encourage patient-centered treatment and promote family participation.

Treatment

Plans should follow clinically-proven guidelines to motivate and treat, employing appropriate counseling, anti-craving medications, brief intervention, self-help, relapse prevention techniques and other methods.

Plans should implement treatment interventions appropriate for the severity of the alcohol use disorder.

People hospitalized or medically stabilized through inpatient, emergency room or outpatient detoxification should receive a follow-up visit within 72 hours of discharge.

Every patient should have a recovery plan that includes follow-up, relapse prevention and education.

Eve Raskin and Lynora Williams, September 2003