MADISON- Using cost-effective health educators rather than physicians and nurses to screen and coach Medicaid patients on alcohol and other drug use could save states hundreds of millions of dollars a year, according to a study by the Population Health Institute of the University of Wisconsin School of Medicine and Public Health.

“We found that expanding the health care team to include health educators to handle alcohol and other drug screening is a low-cost option that results in two-year estimated net savings of $782 per Medicaid patient who undergoes screening,” said study co-author Dr. Richard Brown, professor of family medicine at the School of Medicine and Public Health.  “A major barrier to screening for alcohol and other drug use and other behavioral issues is that doctors and nurses are busy diagnosing and treating patients and don’t have the time.”  The study, published in the Journal of Behavioral Health Services and Research, spelled out how Medicaid costs are reduced.

“Inpatient days dropped and lower-cost outpatient visits increased significantly when Medicaid patients were screened and treated as necessary by paraprofessionals,” said lead author Jason Paltzer, researcher in the Population Health Institute.

Paraprofessionals including health educators, counselors and social workers were trained by the Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) in screening, brief intervention and referral to treatment (SBIRT).

The researchers examined health care claims of more than 14,000 Medicaid recipients  ages 18 to 64 over three years.  Roughly 7400 were screened for substance use while about 6700 received treatment-as-usual (no screening) in 33 health care settings, mainly primary care clinics in Wisconsin. Clinics were expected to screen universally among the test group rather than target those with suspected risky alcohol and other drug use behaviors.  The WIPHL four-question universal screening was used.  Completing the questionnaire with or without further assessment or intervention counted as treatment in the study.

Patients with a positive screen were referred to paraprofessionals for further assessment with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).  Depending on the test results, patients received reassurance, brief intervention or referral to treatment.  Intervention and referral included feedback, education, recommendations and motivational interviewing.

“The health educators are trained in a respectful and collaborative approach rather than lecturing or judging patients’ use of alcohol or other drugs,” said Brown.  “They help patients take stock of the pros and cons of cutting or stopping alcohol or other drug use.  Health educators are trained to respect patients’ decisions.”

“People eligible for both Medicaid and Medicare showed even greater decreases in inpatient admissions and shorter hospital stays and bigger increases in outpatient visits,” said Paltzer.  “This suggests that targeting services to such high-cost patient groups may yield larger reductions in expensive health care and meaningful cost savings.”

Paltzer and Brown said the study has important policy implications. In many states, alcohol and other drug screening are not reimbursed by Medicaid when the screening and coaching is done by health educators.  Although Wisconsin Medicaid does reimburse when paraprofessionals provide screening services, most Medicaid recipients do not currently receive SBIRT.

The researchers plan to conduct additional analyses to confirm these results.  The study was funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

Published: June 2016