A state contracting program that paid addiction treatment providers based on outcomes resulted in better service quality and accountability, according to a study by the Treatment Research Institute.

Researcher Tom McLellan, Ph.D., and colleagues studied the state of Delaware's results-oriented contracting system and concluded that providers "improved their ability to attract patients and keep them engaged in treatment longer -- both signs of improved addiction treatment quality and accountability for services."

States typically pay providers on a fixed contract basis or based on the number of patients they treat, but Delaware switched to performance-based contracting in 2002, paying providers more or less depending upon whether they met certain targets for capacity utilization and retention of patients in treatment.

Between 2001 and 2006, capacity utilization among Delaware providers rose from 54 percent to 95 percent, while the average for patients actively participating in treatment for more than 30 days increased from 53 percent to 70 percent. The improvements were realized despite the fact that programs tended to take in patients with more severe addiction problems over the course of the study.

"Substance abuse treatment providers who stood to gain or lose financially under the contract system may have taken steps to make their services more appealing to patients and do more to integrate evidence-based practices," McLellan said.

The study was published online in the journal Health Policy.