Health Care Utilization After Paraprofessional-administered Substance Use Screening, Brief Intervention, and Referral to Treatment: A Multi-level Cost-offset Analysis
Open accessAbstract
Background: Authorities recommend universal substance use screening, brief intervention, and referral to treatment (SBIRT) for all (ie, universal) adult primary care patients. Objective: The objective of this study was to examine long-term (24-mo) changes in health care utilization and costs associated with receipt of universal substance use SBIRT implemented by paraprofessionals in primary care settings. Research Design: This study used a difference-in-differences design and Medicaid administrative data to assess changes in health care use among Medicaid beneficiaries receiving SBIRT. The difference-in-differences estimates were used in a Monte Carlo simulation to estimate potential cost-offsets associated with SBIRT. Subjects: The treatment patients were Medicaid beneficiaries who completed a 4-question substance use screen as part of an SBIRT demonstration program between 2006 and 2011. Comparison Medicaid patients were randomly selected from matched clinics in Wisconsin. Measures: The study includes 4 health care utilization measures: outpatient days; inpatient length of stay; inpatient admissions; and emergency department admissions. Each outcome was assigned a unit cost based on mean Wisconsin Medicaid fee-for-service reimbursement amounts. Results: We found an annual increase of 1.68 outpatient days (P=0.027) and a nonsignificant annual decrease in inpatient days of 0.67 days (P=0.087) associated with SBIRT. The estimates indicate that the cost of a universal SBIRT program could be offset by reductions in inpatient utilization with an annual net cost savings of $782 per patient. Conclusions: Paraprofessional-delivered universal SBIRT is likely to yield health care cost savings and is a cost-effective mechanism for integrating behavioral health services in primary care settings.
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Sustainable change requires more than time-efficient provider training; it depends on workflow alignment, leadership support, and organizational readiness.
“However, as shown in the South African Teachable Moment study [13], sustainable change requires more than time-efficient provider training. It depends on workflow alignment, leadership support, and organizational readiness [9,18,20,32].”
From Screening, brief intervention, and referral to treatment training for Nigerian primary care physicians: A pilot evaluation of knowledge, attitudes, self-efficacy, and barriers to implementation (2025) · cites this paper as [9]
The Discussion (page not provided) says administrators must identify an effective SBIRT workflow and describes a local champion and interprofessional team as implementation best practices. This supports workflow alignment and aspects of leadership support, but the paper does not establish organizational readiness as a requirement for sustainable change. The preceding statement about time-efficient training is cited to [13], not this source. (LLM, conf=0.84)
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“In high-income countries, SBIRT reduces hazardous use by 10–30%, improve treatment engagement, and lower long-term healthcare costs, with sustained effects over 12–48 months [7,9,10].”
- Authors
- Paltzer, J., Moberg, D. P., Burns, M., & Brown, R. L.
- Affiliations
- University of Wisconsin–Madison (US)
- ConcertoHealth, Kalamazoo, MI
- Corresponding author
- Paltzer, Jason
- Venue
- Medical Care
- Published
- 2019-09
- Volume
- 57
- Issue
- 9
- Pages
- 673-679
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC6690790
- OpenAlex
- W2959163470
- Cited by
- 16
- References
- 45
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 3 · 2021: 2
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R03AA025196)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- substance use screening, brief intervention, referral to treatment, paraprofessionals, primary care, Medicaid beneficiaries, health care utilization, health care costs, cost reduction, behavioral health integration, outpatient visits, hospitalization, emergency department admission
- MeSH terms
- Adult, Cost-Benefit Analysis, Costs and Cost Analysis, Female, Health Plan Implementation, Humans, Male, Mass Screening, Patient Acceptance of Health Care, Primary Health Care, Psychotherapy, Brief, Referral and Consultation, Linear Models, Health Care Costs, Substance-Related Disorders, Multilevel Analysis
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