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The Washington Circle Group

Efforts to improve the quality of the substance use disorder treatment system are aided by the development, use and tracking of standardized measures that track the quality of alcohol and other drug (AOD) treatment services.  The Washington Circle Group is an organization focused on the development and dissemination of such measures.  The three initial measures developed by the Washington Circle for the treatment of Alcohol and Other Drug Use were: Identification of adults with an AOD disorder, Initiation of AOD services, and Continuation of AOD services.  A brief description of each measure is provided below:

Identification:  The percentage of adult enrollees with a substance abuse claim, defined as containing a diagnosis of substance abuse or dependence or a specific substance abuse-related service, on an annual basis.

Initiation: The percentage of adults aged 18 and over diagnosed with AOD abuse or dependence and receiving a related service who initiate treatment through one of the following:

  • An inpatient AOD admission, or
  • An outpatient service for AOD abuse or dependence and any additional AOD services within 14 days

Engagement: The percentage of adults with two additional AOD treatments within 30 days after initiating treatment.
While these three measures were initially developed for commercial populations, the Washington Circle assembled a workgroup to assess the feasibility and utility of using these measures within the public sector.  The workgroup included representatives from a number of public sector users including substance abuse and mental health agencies in twelve states. Workgroup findings suggested that the calculation of the identification measure may be problematic for many public sector agencies given that many states do not serve fixed enrolled populations, and thus calculating the total number of individuals eligible for care in a given year may be difficult, or even impossible.   However, the workgroup found that the other two measures- initiation and engagement were both useful with some modifications. The workgroup suggested the initiation and engagement measures be expanded to include the following:

  • Initiation after outpatient
  • Initiation after intensive outpatient
  • Engagement after outpatient
  • Engagement after outpatient or intensive outpatient

It is worth noting that many Medicaid HMOs are able to collect and report on the results of the three HEDIS measures collected by NCQA. More information on the results of these measures, and developing expectations for Medicaid plans that collect this information can be found here.

For More Information:

More information on the Washington Circle Public Sector Workgroup can be found here.

Detailed specifications for the three measures described above can be found here.

Preliminary research suggesting an association between increased adherence to Washington Circle measures and decreased criminal justice involvement can be found here.