The overall goal of the Brandeis-Maine Study is to obtain a better understanding of the effects of financial incentives within addiction treatment programs. The study focuses on outpatient (OP) and intensive outpatient (IOP) substance abuse treatment agencies for adults that are paid under Maine’s incentivized contract. Agencies that do not receive SAMHS funding will serve as a comparison group.
List of Questions by Category:
What are the study benefits and/or burden involved for my agency?
- What does the study involve?
- How will our agency benefit from the study?
- How much work will it be for my agency to be involved in this project?
- Will we have to collect or submit additional data beyond what we already do?
Study Design
- How are you selecting agencies to participate?
- How does participation affect the incentivized contract?
- What is the Phase 2 clinician experiment?
- Do clinicians and staff have to participate in Phase 2 if the agency participates?
- Can an agency move from the no-incentive group to the incentive group (or vice versa) during Phase 2?
- How are individual clinicians and staff evaluated in the Phase 2 clinician experiment?
- What if an agency has multiple locations?
- What if a clinician works in both an incentivized and non-incentivized agency?
- What if our performance rates stay the same? Will clinicians be eligible to get an incentive payment or will we be penalized?
Financial Aspects
- If my agency is not in the incentives arm, can I get any more money for my staff?
- How much can my clinicians and staff earn in incentives?
- When will clinicians and staff receive the incentives?
- For how long will agencies be able to receive incentives? (e.g., how many quarters?)
- Are there any penalties/risk of lower payment as part of this project?
- How much money is the state spending on this project?
- Our agency budgets are already very tight and our staff are overstretched. How will we be able to improve engagement/continuity rates without additional funding?
- Who is funding this study?
Confidentiality
- Who will see information on my clients and how are you respecting client confidentiality?
- Who will know which clinicians and staff participate in Phase 2 of the study?
- Will we have to obtain client consent for anything related to the project?
Future Plans
- How will you share study findings with the participating agencies?
- When will study findings be available?
- If the study determines that incentives paid directly to clinicians and staff improve program performance and client outcomes, will Maine adopt these approaches?
- How will this study relate to current performance based contracting in Maine?
Who can I contact if I have questions about this project?
Questions with Answers
What are the study benefits and/or burden involved for my agency?
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In Phase 1 of the study we will examine the impact of the incentivized contract and how agencies and clinicians have adapted to it. To do this, we will ask program directors in OP/IOP agencies licensed by DHHS/DLRS, whether or not they have an incentivized contract, to conduct an in-person or telephone interview in the fall of 2013. Then, in late fall or winter 2013, we will ask clinicians and staff to complete a 10-minute online survey. All participants will receive an honorarium for completing the interview or the survey (see below).
In Phase 2 of the study we will provide financial incentives directly to clinicians and front-line staff in some agencies that have an incentivized contract. In fall of 2014 we will invite all agencies with an incentivized contract to participate in this phase of the study, although only some agencies will be randomly selected to receive the incentives. For all agencies with the incentivized contract this also means we will ask to conduct an interview with the program director and will ask the clinicians and staff to complete an online survey, both in the winter of 2014 and the spring of 2015. Additional detail about Phase 2 will be made available in 2014.
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How will our agency benefit from the study?
First, this is an opportunity to provide your perspective on Maine’s incentivized contract and performance measures. It is also an opportunity for your clinicians to share their perspectives.
Second, this study may contribute to a better understanding of how to use financial incentives to improve service delivery and quality of care. This may benefit your agency directly or the knowledge may benefit other agencies like yours in Maine or other states.
Finally, clinicians and front line staff may benefit if your agency is one of those randomly selected to be eligible for financial incentives in phase two.
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How much work will it be for my agency to be involved in this project?
The burden to your agency will be minimal. We will ask to conduct an interview with the program director to hear your perspective on the performance contract. This interview will take about 1 hour and you will receive $50 for participating. The interview is accompanied by a brief online program director survey. We will also ask for a list of all outpatient clinicians and front-line staff at your agency. These staff will be asked to participate in a 10 minute online survey regarding the incentivized contract. Survey participants will also be paid for participating.
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Will we have to collect or submit additional data beyond what we already do?
No additional data collection or submission is needed. The interview and surveys will include only questions to be answered “off the top of your head.”
Study Design
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How are you selecting agencies to participate?
In Phase 1 the study will include most adult outpatient and intensive outpatient substance use treatment agencies in Maine that have an incentivized contract with SAMHS and a selection of agencies that do not receive SAMHS funding. All of these agencies will be invited to participate in the program director interviews and the clinician surveys.
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How does participation affect the incentivized contract?
The study does not change any aspect of your contract with SAMHS. We will ask you about the contract and your response to it, but the performance measures and the incentives (or penalties) associated with your contract remain unchanged. For Phase 2, the clinician incentives will be provided in addition to the agency incentives from SAMHS.
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What is the Phase 2 clinician experiment?
In Phase 2, we will provide incentive payments directly to clinicians and front-line staff within agencies with incentivized contracts. Phase 2 will use the same performance measures as in the incentivized contract. Agencies will be randomized to receive the clinician incentive (or not) and all appropriate staff within that agency will be eligible for the incentive. If an agency has multiple sites in Maine, all sites will be randomized into the same study condition. Additional detail about Phase 2 will be made available in 2014.
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Do clinicians and staff have to participate in Phase 2 if the agency participates?
No. Although we hope that all clinicians and front-line staff will participate in the study, as that will make the study stronger, we acknowledge that not all clinicians or staff will choose to participate. The study will be introduced directly to clinicians and staff, they will have a chance to ask questions, and they will provide consent if they agree to be in the study. At any time participants can choose to exit the study.
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Can an agency move from the no-incentive group to the incentive group (or vice versa) during Phase 2?
No. If agencies were allowed to change groups during the study, this would prevent us from evaluating whether incentives paid directly to clinicians and front-line staff are associated with improvement in agencies’ performance.
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How are individual clinicians and staff evaluated in the Phase 2 clinician experiment?
Clinicians and staff in agencies randomized to receive additional incentives will be measured based on the performance of the entire agency, NOT based on individual performance. We do not have information to link clinicians and staff to clients and we want to encourage colleagues in an agency to work together to improve outcomes for their clients, therefore incentives are based on results for the entire agency.
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What if an agency has multiple locations?
If an agency has multiple physical locations each location or site will be evaluated separately. One location may reach the incentive goal while another location does not. However, all sites within an agency will be randomized to the same group – either incentives or not – so that any clinicians or staff that are shared across locations are in the same intervention group.
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What if a clinician works in both an incentivized and non-incentivized agency?
That’s fine. In this case the clinician would receive incentives based on the results of the incentivized agency and would not receive payment for the outcomes in the non-incentivized agency.
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What if our performance rates stay the same? Will clinicians be eligible to get an incentive payment or will we be penalized?
There are no penalties. An agency in Phase 2 that is randomized to the incentives condition can receive incentive payments when their performance rates meet a benchmark level. If your agency was already at the benchmark prior to Phase 2 and it maintains that performance level, your clinicians and front-line staff will still receive the incentive payment.
Financial Aspects
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If my agency is not in the incentives arm, can I get any more money for my staff?
This project is not able to offer additional money to agencies not randomized to receive incentives.
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How much can my clinicians and staff earn in incentives?
We are still working on the specifics of the incentives design and will consult with SAMHS, MASAP and treatment providers as we finalize this aspect.
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When will clinicians and staff receive the incentives?
Incentives will be sent out directly to clinicians shortly after the end of each quarter.
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For how long will agencies be able to receive incentives? (e.g., how many quarters?)
The study runs for 1 year. Agencies in the incentives groups will be able to earn incentives for each of the 4 quarters in that year.
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Are there any penalties/risk of lower payment as part of this project?
There are no penalties or risk of lower payment.
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How much money is the state spending on this project?
The state is not spending any money on the study. The incentive payments to clinicians and staff are funded by the research study.
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Our agency budgets are already very tight and our staff are overstretched. How will we be able to improve engagement/continuity rates without additional funding?
Like NIATx, we believe that it is possible to improve performance with existing resources given appropriate support.
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The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), is funding Brandeis University to conduct this study.
Confidentiality
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Who will see information on my clients and how are you respecting client confidentiality?
Brandeis University researchers collaborating with SAMHS will only see de-identified admission and discharge data that your agency already submits to SAMHS. We will not have access to client names, addresses or other identifying information.
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Who will know which clinicians and staff participate in Phase 2 of the study?
Only Brandeis researchers will know which clinicians and staff agree to participate. Clinician participation will be kept confidential from program directors and SAMHS.
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Will we have to obtain client consent for anything related to the project?
No. The study will use only de-identified, existing data routinely collected by SAMHS. Any data that is shared with Brandeis researchers will be provided in a way that prevents identifying specific clients. If your study is randomized to be eligible for additional incentives during Phase 2, you will be asked to post an informational notice where clients will see it, but their consent is not required.
This study has been approved by the Brandeis University Institutional Review Board. For questions about the human subjects or other research conduct concerns, please conduct the IRB administrator at 781-736-8133, or irb@irb.brandeis.edu.
Future Plans
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How will you share study findings with the participating agencies?
We will develop brief reports of the results and will make presentations to agencies in Maine. We also plan to make these briefs, Power Point presentations and academic research papers available on our website and on the SAMHS website if possible.
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When will study findings be available?
Results from the first set of interviews and surveys will be available in mid-2014. Results from Phase 2 will not be available until 2016, once the incentive portion is complete and data are analyzed.
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If the study determines that incentives paid directly to clinicians and staff improve program performance and client outcomes, will Maine adopt these approaches?
If payments directly to clinicians and staff produce a degree of improvement in program performance that offsets the cost of providing incentives, SAMHS may consider adopting this approach.
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How will this study relate to current performance based contracting in Maine?
At this point, current performance targets are not being changed. Depending on the findings from the study, SAMHS may revise current performance measures and targets.
Who can I contact if I have questions about this project?
- Maureen Stewart at Brandeis University, mstewart@brandeis.edu, 781-736-3717
- Sharon Reif at Brandeis University, reif@brandeis.edu, 781-736-3924
- Stacey Chandler at SAMHS, stacey.chandler@maine.gov, 207-287-6337
- Brandeis University Institutional Review Board (IRB), irb@brandeis.edu, 781-736-8133
Key Project Staff (Brandeis University)
- Sharon Reif, Principal Investigator, reif@brandeis.edu, 781-736-3924
- Maureen Stewart, Project Manager and Co-Investigator, mstewart@brandeis.edu, 781-736-3717
- Margot Davis, Lead Interviewer and Co-Investigator, margotd@brandeis.edu, 781-736-3850
- Maria Torres, Interviewer and Co-Investigator, mtorres@brandeis.edu, 781-736-4836