About the Center
The Brandeis-Harvard SPIRE Center seeks to enhance the effectiveness and impact of existing research on delivery and payment of substance use disorder (SUD) treatment services, and offer a national resource for those researching and designing SUD treatment systems and policy in the context of ongoing, dramatic changes in the US health care system. The Center’s goal is to conduct and extend research on service delivery and payment to synergistically expand the research base, informing policy and practice decisions that will profoundly affect the cost, quality, and availability of SUD services.
SPIRE Center Staff and Researchers
The intertwined nature of delivery and payment systems requires attention to both in order to achieve sustainability of high value systems innovations. While continuing to emphasize innovations in delivery and payment systems broadly defined, the Center also brings intentional focus to low-barrier settings for treatment (i.e., wholly outside of or extensions of specialty SUD settings such as emergency departments, pharmacies, and telehealth), as well as quality improvement, and factors that influence sustainability of innovation. The Center also expands the science around Medicaid managed care, given the importance of Medicaid as a payer of SUD services, and the dominant role of private Medicaid health plans. The Center builds on three Component research projects, as well as related research at our organizations and elsewhere, and support the development of new research to provide crucial and timely evidence that can inform the design and implementation of effective policy and practice.
The Administrative, Research, Policy/Dissemination, and Pilot/Mentoring Cores provide the organizational engine to promote cross-fertilization of findings across projects to support the Center’s aims:
- advance the science by conducting and stimulating research and knowledge development about payment and delivery system innovation for SUD treatment
- drive the next generation of research by mentoring and training early career investigators and creating networks of early career and senior researchers
- engage with key stakeholders in a bidirectional exchange to produce timely and relevant research that informs and influences policy and practice.
To achieve these aims, the Center extends the research base to include critical analyses of timely and emerging topics identified in close collaboration with key stakeholders. We do this through activities that include empirical and conceptual papers; short- and longer-term analyses targeted at pressing issues for policy and practice; and multiple mentoring programs and activities to support early career investigators. Further, we continue to translate and disseminate findings to an expansive audience of policy makers, payers, providers, persons with lived experience of SUD, and researchers to inform the changing environment of delivery and payment of SUD treatment services.
The Center is co- directed by Sharon Reif, PhD of Brandeis University and and Haiden Huskamp, PhD, of Harvard University. It is housed at the Institute for Behavioral Health at the Heller School for Social Policy and Management, Brandeis University, and the Department of Health Care Policy at Harvard Medical School, with administrative activities based at Brandeis. Each organization brings a unique set of substantive skills that strengthens the collective expertise offered by the Center. Considered together, we bring the necessary expertise and structure required to tackle sophisticated issues and to conduct rigorous and coordinated research to improve the quality of SUD treatment.
History
The Center was originally established in 1995 as the Brandeis-Harvard NIDA Center on Managed Care and Drug Abuse Treatment. At that time, drug abuse treatment in both the public and private sectors was increasingly being delivered in a managed care environment; therefore, the Center focused on assessing the effects of managed care on drug abuse treatment availability, content, duration, and utilization, as well as on treatment financing and organization. Although managed care was expanding rapidly, little was known about what it actually involved and, more importantly, what its impact might be. The original iteration of the NIDA Center (1995-2003) might be thought of as conducting “first generation” studies that sought to describe the “black box” of managed care, examine its growth, and compare its impact on cost and utilization to more traditional healthcare delivery/payment arrangements.
Since managed care covers such a large part of the U.S. population and is continually changing, it was essential to drive center research towards understanding which specific elements of managed care make a difference in the effective delivery of substance abuse services. The second iteration of the Center (2005-2013) built on the understanding that the ubiquitous use of managed care strategies within the current health care system has not uniformly led to the delivery of effective care. Center research focused on identifying which specific elements of organization, management, financing and payment make a difference in effective drug abuse service delivery, and understanding how incentives within these four areas can be used to encourage or support better quality in drug abuse treatment services.
In its third iteration (2015-present), the Brandeis-Harvard NIDA Center gravitated towards a broader systems perspective, focusing on improving the quality of healthcare. The Center is highly innovative in that it explicitly recognizes that payment and delivery systems are intrinsically intertwined and must be considered together in order to advance the science. The Center also branches out beyond academia, engaging in the real world to learn how payment and delivery system changes are playing out for the payers, provider organizations and clinicians across the country.
Conceptual Framework
Research Questions and Activities
