SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 1

Grantee Experience: Voucher Management Systems 

as a Program and Financial Management Tool

Introduction

Electronic information management is a distinguishing 

attribute of the Access to Recovery (ATR) project. The 

ATR requirement for implementation of an electronic 

voucher management system (VMS) helps ensure 

grantees have ready access to both aggregate and 

provider-specific data. The required collection of data 

at designated intervals, as outlined by the Government 

Performance and Results Act (GPRA), creates a clientspecific database that documents changes over time in 

the client’s key life domains, and these changes have a 

strong association with client recovery. 

Data from the VMS and GPRA systems can be used to 

build financial and program management tools and 

to compile reports that aid ATR grantees in monitoring, reviewing, and adjusting programs supported 

by client- and system-level data. For some grantees, 

the depth and breadth of data and the accessibility of 

this information is unique to ATR, which has proven 

invaluable to the successful management of all aspects 

of the ATR project.

What’s in this TA Package?

Many grantees have established integrated systems 

of data and report review mechanisms in support of 

data-driven decision making pertaining to key aspects 

of their programs, including client retention, referral 

systems, service types and utilization, provider access, 

outcomes, and return on investment. This ongoing 

commitment to continuous quality improvement of 

the ATR program allows for flexibility and responsiveness while still maintaining the core ATR values and 

including a choice of services and providers for the 

client that truly supports a recovery-oriented system 

of care. Examples of these reports and the local datadriven decision-making processes that occur are the 

focus of this TA Package.

Contents:

Part 1: From Data to Information: Data-Driven Decision 

Making

Part 2: Grantee Examples: Data, Reports, and the VMS

Part 3: References and Additional Resources

Using Voucher Management Systems to Successfully 

Manage ATR Projects

•	 	Understand	how	data-driven	decision	making	is	

created	through	the	use	of	a	voucher	management	

system.

•	 	Demonstrate	how	grantees	can	use	VMS	data	in	key	

programmatic	and	fiscal	areas	to	successfully	manage	ATR	projects.

•	 	Present	ATR	grantee	perspectives	on	the	benefits	

of	using	reporting	tools	and	the	solutions	that	have	

supported	efforts	in	monitoring	the	ATR	program.

•	 	Explain	how	these	tools	and	solutions	can	impact	all	

ATR	grantees’	project	management	decisions.
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 2

How should grantees use this information?

This TA Package features information, resources, tips, 

and tools from seven ATR 3 grantees. It is designed to 

help you understand how data in your VMS and the 

GPRA can be used for financial and program management of your ATR program. Inside, you also will read 

about the experiences and lessons learned by ATR 

grantees as they implemented VMS and GPRA datagenerated reports to implement data-driven decision 

making and a system of continuous quality improvement to their ATR program. 

Part 1: From Data to Information: 

Data-Driven Decision Making

An essential feature of the ATR grant is the use of 

vouchers as a payment mechanism for client services. 

Vouchers place control of the type of services, the 

provider, and service participation in the hands of the 

client. ATR grantees are required to implement an electronic VMS. Some grantees chose to build their own 

systems while others chose off-the-shelf products. The 

creation of information from data and the timely, systematic review of the information available from ATR 

reports, which are based on the data found in both 

the program’s VMS and GPRA outcome, are essential 

for sound financial and program management of ATR 

regardless of the type of system used by the grantee.

The concept of and reasons for data-driven 

decision making

Success	in	business	planning	and	management	

requires	that	we	move	away	from	a	traditional	model	

that	provides	purely	financial	and	retrospective	information	and	uses	best	guesses	for	decision	making	

to	a	model	that	uses	forward-looking	and	insightful	

measurement	and	analysis	to	make	key	decisions.	

This	measurement	culture—where	business	decisions	

are	made	based	on	a	careful	blend	of	both	data	and	

intuition—is	an	organizational	environment	where	staff	

have	a	keen	understanding	of	the	information	they	

need	to	do	their	jobs	effectively	and	how	to	obtain	

and	use	this	data.	It	is	a	culture	where	organizational	

performance	is	driven	by	measuring,	reporting,	and	

managing	key	strategic	and	operational	metrics.	

http://www.openminds.com/market-intelligence/

intelligence-updates/pebmpi09data.htm

Both the implementation of a VMS and the regular 

collection of GPRA data for each ATR participant 

foster greater interaction among program directors and 

data personnel. This increased contact and reliance 

on new knowledge, skills, and abilities requires ATR 

staff to develop and implement new ways of working 

with each other to best manage the complexities of a 

voucher-based system of reimbursement. ATR grantees 

are challenged to approach data and reporting in a way 

that is often different from traditional substance abuse 

service programs that typically use a limited number 

of providers with contracts based on fixed funding 

amounts, fixed client numbers, and more limited data 

and outcome collection requirements. 

Additionally, ATR requires grantees to include a 

process for data-driven decision making and continuous quality improvement as a regular part of program 

implementation and to incorporate new and diversely 

trained team members. Given the amount of data 

contained in the VMS, ATR grantees are primed to 

implement the process of data-driven decision making and continuous quality improvement much more 

quickly than traditional substance abuse service 

programs or funding streams. Client-level data collected via the VMS offers grantees a wealth of financial 

and program data that can easily be used to monitor 

service costs and array. 

With ATR’s additional requirement to collect clientlevel outcome data that measure change over time 

(through GPRA scores), grantees are in a unique position to use VMS data in multiple ways. For example, 

What is the difference between data and 

information?

Data	refers	to	the	lowest	abstract	or	raw	input	which,	

when	processed	or	arranged,	makes	meaningful	output.	

It	is	the	group	or	chunks	which	represent	quantitative	and	

qualitative	attributes	pertaining	to	variables.	Information	is	

usually	the	processed	outcome	of	data.	More	specifically	

speaking,	it	is	derived	from	data.	Information	is	a	concept	

and	can	be	used	in	many	domains.

http://www.differencebetween.net/language/

difference-between-data-and-information/
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 3

grantees are able to identify service and provider 

issues; adjust service arrays and rates; monitor client access to and retention in services; identify and 

act quickly on cases of waste, fraud, and abuse; and 

identify service arrays (clinical and/or recovery support systems) that achieve the best client outcomes 

for target populations. This data collection and review 

process also provides grantees the tools needed to 

engage in continuous quality improvement of their 

ATR program. 

ATR grant requirements compel grantees to approach 

management of the project differently from other 

Federal and State funding streams. Given the complexities of the ATR approach and the robust data contained 

in the VMS, grantees use a number of key reports and 

tools to continuously monitor and improve the program. 

Building on the varied experience of the required ATR 

staff, grantees have implemented a variety of frameworks to design, use, and redesign these reports and 

tools to continually improve their ATR projects. Within 

these frameworks, information needs are identified, 

definitions of terms are clarified, data elements are 

established, and report formats are created, often in collaboration with all members of the ATR team. 

Voucher management systems are more than a means 

to pay for services. With a thoughtful and ongoing 

report development process to implement the principles 

of data-driven decision making and continuous quality 

improvement, the VMS can also be the basis of behavioral health care service management systems. The goal 

of ATR is the design of behavioral health service systems that provide the right mix of services at the right 

cost, that produce the right outcomes in an environment 

of client-directed care at a chosen provider, and that 

afford an immediate awareness of and responsiveness to 

both negative and positive events. 

Part 2: Grantee Examples: Data, Reports, 

and the VMS

The vast array of data elements contained within 

grantees’ voucher management systems can be 

overwhelming, especially for new ATR grantees. 

Additionally, ATR grantees are required to simultaneously manage a multitude of financial and program 

requirements in order to implement and sustain a successful ATR project. Given this complexity, seven key 

areas for successful management of ATR funds and 

programs are identified, along with the kinds of reports 

that are often used to inform each area, in the table on 

the following page. ATR project directors report considerable overlap between areas in their day-to-day project 

management with reports and tools often providing 

critical information in several key areas at once. Grantees 

also identify a hierarchy of reports within this construct, 

noting that reports on budgeting and spending were 

essential “first-tier” tools that require ATR staff mastery 

prior to the development of other reports and tools.

Finally, project directors note that, while reports provide 

a snapshot of potential issues in each of these areas, 

each project director also relies on additional inquiry 

to fully assess the issue or situation. Reports help focus 

these inquiries and concurrently trigger the development of new reports and tools that support a system of 

continuous quality improvement founded in data-driven 

decision making.

Seven ATR project directors were contacted to gather 

the greatest array of experience and expertise in using 

the VMS as an ATR financial and program management 

tool. Each of the project directors was asked to provide 

a sample of the report(s) they use in one of the key 

management areas listed in the table and to discuss the 

following items:

•	 The	importance	of	the	report(s)	and	how	ATR	staff	use	

the report(s) as a program or financial management tool.

•	 The	frequency	of	report	generation	and	review	along	

with identification of key data elements.

Continuous Quality Improvement

An	approach	to	improving	and	maintaining	quality	

that	emphasizes	regular,	internally	driven	assessments	of	potential	causes	of	quality	defects,	followed	

by	action	aimed	at	either	avoiding	a	reduction	in	quality	or	correcting	the	quality	defect	at	an	early	stage.

—USAID	From	the	American	People	

http://www.hciproject.org/improvement_tools/

improvement_methods/approaches/quality
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 4

•	 Lessons	learned,	including	examples	of	actual	findings and results.

•	 How	the	report(s)	contribute	to	meeting	the	goals	of	

ATR,	which	includes	both	SAMHSA-mandated	and	

grantee-defined parameters. 

Area 1: Budgeting and Spending 

A unique component of ATR is the use of vouchers to 

pay for approved clinical and recovery support services, which places the control of these funds directly 

with clients via VMS. ATR services are delivered in 

expanded provider networks that require continuous 

monitoring in order to meet client target requirements 

within budget parameters. Grantees have developed 

an array of spreadsheets, reports, and tools using data 

from their VMS that allow for monitoring of critical 

budget and spending status. 

Ohio’s Choice for Recovery ATR project provided 

their Performance Dashboard as an example of a key 

financial management tool related to budgeting and 

spending of ATR funds.

Ohio’s ATR Performance Dashboard Report

Purpose and Importance

The ATR Performance Dashboard Report was developed to provide a snapshot of funding patterns based 

on data entered into the VMS. The report allows stakeholders to review important funding information in an 

easy-to-read, comprehensive format. This report was 

developed in collaboration with several stakeholder 

agencies to ensure the information provided was useful to multiple partners. 

Report Elements and Use

Clients Served provides the number of clients that have 

been enrolled into the ATR program. Breaking this 

report out by fiscal year and by service type allows the 

ATR project director to view broad trends in service 

patterns as well as keep track of the client targets. 

Total Number of Providers and Dollars Spent by Provider

Type help track the percentage of community and 

faith-based providers active in the network and the 

expenditures on both kinds of providers because the 

grant is predicated on the inclusion of these providers 

in the ATR network.

Area Sample Reports

Budgeting and Spending - Projected and actual spending

- Projected and actual monthly targets by 

clients, locations, services, providers, special 

populations, etc.

- Regional capacity of providers, networks, 

population size, substance issue, etc. 

Services - Tracking the comparison of services of interest with actual services referred and used

- Provider capacity and utilization

- Services by provider location or network

Client Choice - Referral source

- Provider referrals report

- Client satisfaction by referral and provider 

source

- Service utilization and service completion 

rates

- Client requests for changes in providers

Rates - Services by amounts and numbers served

- Outliers services: under- or overused services 

by dollars, client numbers, and providers

Fraud, Waste, and 

Abuse

- Establishment of typical service delivery 

protocols

- Reports on individual provider billing outside 

of typical service delivery protocol (i.e., 

“red-flagged”)

- Chart and service documentation audits by 

provider and by client

Client Profiles and Client 

Outcomes 

- Service mix

- Access times

- GPRA data and VMS

- Data exports

- Statistical software

- Data analysis

Care Coordination - Service mix

- Engagement

- Retention in services

- Follow-up
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 5
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 6

Dollars Paid provides an annual snapshot of spending patterns via a monthly breakdown of funds spent. 

These patterns are used to determine the median 

spending amounts as well as appropriate monthly 

budget amounts. 

Dollars Spent on Treatment Clients provides more detail 

on the use of ATR funds. As the treatment services 

are adjusted, changes in spending patterns are tracked 

using these data. With ATR’s focus on the vital roles 

of recovery support services and care coordination, 

changes in spending patterns for clinical services are 

anticipated. 

Dollars Spent by Type of Service provides a big picture 

view of the percentage of funds spent on recovery and 

treatment. Ohio tracks funding expended on treatment 

versus recovery support services to ensure a balanced 

distribution of funds. 

Dollars Spent by County of Residence provides data on 

the percentage of redemption per county. These data 

drive the funding expectations per county as well as 

indicate the outreach and capacity-building needs of 

each county. 

Dollars Spent on Treatment Services and Dollars Spent 

on Recovery Services provide a detailed breakdown of 

spending in the top five services in both categories to 

track actual treatment and recovery service utilization with the percentages of funding redeemed in each 

service category.

Lessons

The ATR Performance Dashboard Report is used in 

a variety of ways to assist with budgeting, forecasting, and tracking of ATR funds. This report provides a 

basic understanding of what services are most widely 

used, what percentage of the spending is from each 

county, and the balance of spending between recovery 

support and treatment dollars. It also tracks enrollment targets. 

Ohio ATR’s project director notes:

The dashboard allowed us to identify an increase 

in spending towards the end of Year 1 that would 

have been unsustainable given the new target and 

funding levels for Year 2. As such, we adjusted our 

ATR service array to address these realities. 

Such a snapshot of voucher redemption data is a good 

way to broadly see the amount of grant funds that are 

spent and where they are being used. Ohio ATR staff 

have found this report to be a useful “big picture” to 

present to ATR stakeholders because it is easy to read 

and provides enough information to gain an understanding of the funding flow in the ATR program. 

Area 2: Services 

The focus of ATR on client-directed services requires 

grantees to continuously review project implementation. Data from the VMS increase the grantee’s ability 

to identify additional client service needs and requests, 

adjust the array of voucher-supported services, and 

track the delivery of services across defined project 

catchment areas. 

New Mexico’s Door to Recovery ATR project provides 

an example of reports and tools generated from their 

VMS data which they use to manage and improve provider networks in the areas of client access, client flow, 

and timely delivery of services. 

Purpose and Importance

New Mexico ATR’s Administrative Referral Chart is a 

snapshot of client referrals by provider in a local ATR 

Central Intake Network. Recovery support service 

(RSS) coordinators are responsible for helping clients 

select their clinical and recovery support services from 

a credentialed array of providers. The primary purpose of this report is to allow New Mexico ATR staff 

to monitor this selection process. Additionally, they 

use this report as a starting point to identify additional 

client needs and requests and to adjust ATR service 

availability as needed based on patterns, such as high 

and low provider referral rates. 

Report Elements and Use

The Administrative Referral Chart includes the name 

of the provider (changed to service type in this example for ease of use), the name of each RSS coordinator 

in that network, and the number of unique individuals 

assigned to each RSS coordinator who have selected each 
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 7

provider. Clients in New Mexico may select up to two 

recovery support services and providers at any time.

New Mexico ATR staff use this report in several ways. 

It helps them identify the types of services being used 

and which providers are being used. It also informs 

decisions on when to stop accepting applications for 

providers for current services and when to provide 

outreach for new providers of either existing or new 

services. 

For example, there are seven acupuncture/massage 

providers in the network, with the four providers 

in yellow receiving only one or two referrals for the 

project year to date; the bulk of the referrals have gone 

to the three providers highlighted in blue. Further 

investigation can reveal if this situation is an anomaly, 

if the referral pattern is consistent over time, and 

the causes for these utilization patterns. Under- and 

overutilization of providers offering the same type of 

services could be due to many issues, including quality 

of care and quantity of providers. 

Also note that, in this report, RSS Coordinator 4 made 

more than 700 referrals for the project year to date, 

which is more than 3.5 times the average number 

of referrals of all RSS coordinators. Alternatively, 

RSS Coordinator 6 made only two referrals. RSS 

Administrative Referral Chart

Project Year to Date

Central Intake Unit: ABC Central Intake

Provider

RSS 

Coordinator 

1

RSS 

Coordinator

2

RSS 

Coordinator

3

RSS 

Coordinator

4

RSS 

Coordinator 

5

RSS 

Coordinator 

6

RSS 

Coordinator

7

RSS 

Coordinator

8

RSS 

Coordinator

 9

Acc/Massage 0 0 0 0 1 0 0 0 0

RSS Array 7 0 5 63 0 0 47 12 0

Alt. Healing 13 0 9 352 0 0 82 22 0

Clinical 0 25 0 0 83 0 0 4 46

Clinical 4 30 4 21 8 0 11 1 20

Clinical 12 0 4 103 0 0 24 0 0

Acc/Massage 0 0 0 0 1 0 0 0 0

Clinical 0 5 0 0 18 0 0 2 31

Acc/Massage 25 0 9 105 0 0 65 13 0

RSS Array 0 5 0 0 4 0 0 2 1

Spiritual 10 0 8 76 0 0 56 22 0

Acc/Massage 0 0 0 0 1 0 0 0 1

Acc/Massage 0 0 0 0 0 0 2 0 0

Acc/Massage 0 13 0 1 16 0 13 3 24

Clinical 0 1 0 0 2 0 0 0 2

Acc/Massage 0 0 0 31 0 0 31 14 0

Clinical 0 15 0 0 30 0 0 1 5

Clinical 0 2 0 0 4 1 0 0 2

Clinical 0 15 1 0 89 0 0 7 33

Clinical 0 11 0 0 32 0 0 1 11

RSS Array 9 8 0 2 33 1 0 7 32

RSS Array 0 2 0 0 6 0 0 0 4
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 8

Coordinator 4 also referred to a single provider 352 

times, nearly three times more than the total of all 

other referrals to that provider. Again, further investigation is needed to understand why referrals are being 

made to ensure that the full array of eligible service 

offerings is available to each client and that referrals 

are not being made beyond provider capacity.

Lessons

New Mexico ATR’s project director notes:

An example of how New Mexico ATR has used the 

Administrative Referral Chart is in regards to 

the provider application process, which is required 

for inclusion in the ATR network. Upon review 

of the data contained in this chart and further 

investigation, the New Mexico ATR team closed the 

application process to new providers of acupuncture/massage due to the low utilization of several 

current providers in the network offering this type 

of service. 

In another New Mexico ATR network (of which 

there are seven total) not represented in this TA 

Package, the Administrative Referral Chart data 

indicated a lack of clinical providers for ATR clients 

in one community and a limited number of agencies providing key recovery support services, such 

as spiritual support, pastoral guidance, and faithbased options, in a third community. In these cases, 

New Mexico ATR staff used the Administrative 

Referral Charts to identify these situations, investigate further, and implement strategies to build the 

capacity so that missing services could be provided 

in those communities. 

Area 3: Client Choice

A central tenant of ATR is client choice, predicated on 

the principle that recovery is personal and unique for 

each individual and must be self-directed to achieve 

the participant’s goals, objectives, and desired outcome. As such, ATR program participants use their 

vouchers to select the types of services they want, the 

providers of these selected services, and the frequency 

and intensity of these services. 

The increase in the types of services financed under 

the ATR program and the requisite expansion of the 

provider network for these services can compromise 

client choice, especially when a provider is authorized 

to provide multiple services. Grantees have developed 

reports and tools to help identify potential instances of a 

lack of genuine client choice in their service selection. 

Iowa ATR provides a chart of their Claims 

Reconciliation Tool, which is used to manage several 

key areas of the Iowa ATR grant and as the basis for 

ongoing quality improvement activities. Among the 

uses of this report is the identification of potential 

issues regarding client choice. 

Purpose and Importance

Iowa ATR staff use the Claims Reconciliation Tool to 

identify potential issues around client choice. Using a 

series of data sorting, as illustrated in the charts on 

the following pages, the Iowa ATR project director can 

spot patterns of client utilization that could indicate a 

lack of client choice, particularly in cases where multiple clients receive all of their services from a single 

provider even though other provider choices for these 

services exist. A sample of this pattern is highlighted 

in the Iowa ATR Claims Reconciliation Tool Sort View 

Chart on page 10. 

Report Elements and Use

The Claims Reconciliation Tool includes client identification, provider identification, service type, dates 

of service, and cost of service. Because the data can 

be sorted by each element, this multifunctional report 

is used not only to identify potential issues of client 

choice, but also to:

•	 Conduct	desk	audits	of	providers	and	service	

utilization. 

•	 Evaluate	service	utilization	and	funding	amounts	

allocated.

•	 Conduct	file	audits	during	provider	site	visits	(routine and special requests).

The use of the Claims Reconciliation Tool and the 

subsequent investigation of red-flagged items often 

trigger a quality improvement process, including 
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 9

Iowa ATR Claims Reconciliation Tool Sort Chart

Client ID Provider Service Start Date End Date Adjudicated 

Date Action ChargeAmount Invoice Encounter Created Date

001 IA Provider 1 Supplemental Needs - 

Psychotropic Medication 2/22/12 2/22/12 3/1/12 Paid $28.00 119447 3/1/12

002 IA Provider 2 Care Coordination with GPRA 

Discharge Interview 3/1/12 3/1/12 3/1/12 Paid $40.00 119451 3/1/12

003 IA Provider 3 Transportation - Bus/Cab 3/1/12 3/1/12 3/1/12 Paid $30.00 119453 3/1/12

004 IA Provider 4 Recovery Peer Coaching 3/1/12 3/1/12 3/1/12 Paid $25.00 119461 3/1/12

005 IA Provider 5 Care Coordination with GPRA 

Follow-up Interview 3/1/12 3/1/12 3/1/12 Paid $170.00 119463 3/1/12

006 IA Provider 6 Supplemental Needs - Wellness 3/1/12 3/1/12 3/1/12 Paid $155.00 119464 3/1/12

007 IA Provider 7 Supplemental Needs - 

Clothing/Hygiene 3/1/12 3/1/12 3/1/12 Paid $124.00 119467 3/1/12

008 IA Provider 8 Co-Pays 2/28/12 2/28/12 3/2/12 Paid $5.00 119471 3/2/12

009 IA Provider 9 Supplemental Needs - Utility 

Assistance 3/2/12 3/2/12 3/2/12 Paid $200.00 119473 3/2/12

010 IA Provider 10 Housing Assistance 1/31/12 1/31/12 3/2/12 Paid ($31.00) 119475 2/8/12

010 IA Provider 10 Housing Assistance 2/29/12 2/29/12 3/2/12 Paid $10.00 119475 3/2/12

001 IA Provider 11 Recovery Peer Coaching 3/2/12 3/2/12 3/2/12 Paid $50.00 119477 3/2/12

011 IA Provider 12 Supplemental Needs - 

Gas Cards 3/2/12 3/2/12 3/2/12 Paid $20.00 119479 3/2/12

012 IA Provider 13 Transportation - Bus/Cab 3/1/12 3/1/12 3/2/12 Paid $30.00 119480 3/2/12

013 IA Provider 14 Supplemental Needs - 

Clothing/Hygiene 2/27/12 2/27/12 3/2/12 Paid $123.00 119481 3/2/12

014 IA Provider 15 Care Coordination 2/28/12 2/28/12 3/2/12 Paid $10.00 119484 3/2/12

011 IA Provider 12 Supplemental Needs - 

Clothing/Hygiene 3/9/12 3/9/12 3/9/12 Paid $51.00 119595 3/9/12

015 IA Provider 3 Supplemental Needs - 

Clothing/Hygiene 3/9/12 3/9/12 3/9/12 Paid $109.00 119596 3/9/12

010 IA Provider 14 Co-Pays 1/4/12 1/4/12 3/9/12 Paid $28.00 119597 3/9/12

016 IA Provider 14 Drug Testing 1/5/12 1/5/12 3/9/12 Paid $32.00 119597 3/9/12

011 IA Provider 16 Housing Assistance 3/9/12 3/9/12 3/9/12 Paid $200.00 119604 3/9/12

007 IA Provider 7 Drug Testing 3/9/12 3/9/12 3/9/12 Paid $32.00 119607 3/9/12

017 IA Provider 7 Care Coordination 3/9/12 3/9/12 3/9/12 Paid $10.00 119607 3/9/12

002 IA Provider 17 Recovery Peer Coaching 2/24/12 2/24/12 3/11/12 Paid $50.00 119611 3/11/12

018 IA Provider 18 Transportation - Bus/Cab 3/7/12 3/7/12 3/12/12 Paid $18.00 119615 3/12/12

019 IA Provider 18 Sober Living Activities 3/7/12 3/7/12 3/12/12 Paid $10.00 119615 3/7/12

020 IA Provider 11 Transportation - Bus/Cab 3/6/12 3/6/12 3/12/12 Paid $48.00 119617 3/12/12

021 IA Provider 11 Transportation - Bus/Cab 3/6/12 3/6/12 3/12/12 Paid $48.00 119617 3/12/12

021 IA Provider 11 Drug Testing 3/15/12 3/15/12 3/15/12 Paid $32.00 119680 3/15/12

005 IA Provider 11 Recovery Peer Coaching 3/14/12 3/14/12 3/15/12 Paid $50.00 119680 3/15/12

022 IA Provider 13 ATR Assessment with GPRA

Intake Interview 3/15/12 3/15/12 3/15/12 Paid $125.00 119683 3/15/12

002 IA Provider 14 Co-Pays 1/4/12 1/4/12 3/15/12 Paid $39.00 119684 3/15/12

016 IA Provider 4 Co-Pays 3/15/12 3/15/12 3/15/12 Paid $15.00 119693 3/15/12

023 IA Provider 4 Co-Pays 3/15/12 3/15/12 3/15/12 Paid $8.00 119693 3/15/12

004 IA Provider 6 Supplemental Needs - Gas 

Cards 3/15/12 3/15/12 3/15/12 Paid $20.00 119697 3/15/12

006 IA Provider 19 Care Coordination 2/28/12 2/28/12 3/1/12 Paid $10.00 119451 3/1/12

011 IA Provider 6 Care Coordination 3/1/12 3/1/12 3/1/12 Paid $10.00 119464 3/1/12

008 IA Provider 8 Co-Pays 2/23/12 2/23/12 3/2/12 Paid $5.00 119471 3/2/12
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 10

Iowa ATR Claims Reconciliation Tool Sort View

Client ID Provider Service Start Date End Date Adjudicated

Date Action ChargeAmount Invoice Encounter Created Date

Red Flag Sample 1

100 IA Provider 20 Care Coordination with 

GPRA Discharge Interview 3/21/12 3/21/12 3/21/12 Paid $40.00 119786 3/21/12

100 IA Provider 20 Supplemental Needs - Gas 

Cards 3/2/12 3/2/12 3/6/12 Paid $20.00 119536 3/6/12

101 IA Provider 55 Co-Pays 1/19/12 1/19/12 3/12/12 Paid $4.00 119621 3/12/12

101 IA Provider 55 Supplemental Needs - Gas 

Cards 2/28/12 2/28/12 3/12/12 Paid $20.00 119621 3/12/12

101 IA Provider 55 Supplemental Needs - Gas 

Cards 2/24/12 2/24/12 3/12/12 Paid $20.00 119621 3/12/12

101 IA Provider 55 Supplemental Needs - Gas 

Cards 3/8/12 3/8/12 3/16/12 Paid $20.00 119708 3/16/12

101 IA Provider 55 Supplemental Needs - Gas 

Cards 2/16/12 2/16/12 3/12/12 Paid $20.00 119621 3/12/12

101 IA Provider 12 Care Coordination 2/9/12 2/9/12 3/6/12 Paid $10.00 119538 3/6/12

101 IA Provider 12 Supplemental Needs 

- Clothing/Hygiene 2/29/12 2/29/12 3/6/12 Paid $93.00 119538 3/6/12

102 IA Provider 5 Care Coordination 3/20/12 3/20/12 3/20/12 Paid $10.00 119762 3/20/12

102 IA Provider 5 Care Coordination 3/6/12 3/6/12 3/6/12 Paid $10.00 119535 3/6/12

102 IA Provider 5 Drug Testing 3/6/12 3/6/12 3/6/12 Paid $32.00 119535 3/6/12

102 IA Provider 5 Life Skills Coaching 3/19/12 3/19/12 3/19/12 Paid $25.00 119737 3/19/12

102 IA Provider 5 Recovery Peer Coaching 3/6/12 3/6/12 3/6/12 Paid $25.00 119535 3/6/12

102 IA Provider 5 Supplemental Needs 

- Clothing/Hygiene 3/19/12 3/19/12 3/19/12 Paid $116.00 119737 3/19/12

102 IA Provider 5 Supplemental Needs - Gas 

Cards 3/6/12 3/6/12 3/6/12 Paid $25.00 119535 3/6/12

102 IA Provider 5 Supplemental Needs - Gas 

Cards 3/19/12 3/19/12 3/19/12 Paid $25.00 119737 3/19/12

103 IA Provider 31 Integrated Therapy 3/6/12 3/6/12 3/14/12 Paid $40.00 119666 3/14/12

103 IA Provider 31 Integrated Therapy 3/13/12 3/13/12 3/14/12 Paid $40.00 119666 3/14/12

103 IA Provider 31 Supplemental Needs - Gas 

Cards 3/6/12 3/6/12 3/6/12 Paid $10.00 119532 3/6/12

103 IA Provider 31 Supplemental Needs - Gas 

Cards 2/28/12 2/28/12 3/5/12 Paid $10.00 119508 3/5/12

103 IA Provider 31 Supplemental Needs - Gas 

Cards 3/13/12 3/13/12 3/13/12 Paid $10.00 119642 3/13/12

104 IA Provider 7 Care Coordination 3/6/12 3/6/12 3/8/12 Paid $10.00 119579 3/8/12

104 IA Provider 7 Care Coordination 3/2/12 3/2/12 3/6/12 Paid $10.00 119531 3/6/12

104 IA Provider 7 Supplemental Needs 

- Clothing/Hygiene 3/6/12 3/6/12 3/8/12 Paid $113.00 119579 3/8/12

104 IA Provider 7 Transportation - Bus/Cab 3/2/12 3/2/12 3/6/12 Paid $48.00 119531 3/6/12

104 IA Provider 7 Care Coordination 3/2/12 3/2/12 3/2/12 Paid $20.00 119476 3/2/12

104 IA Provider 7 Care Coordination 3/16/12 3/16/12 3/16/12 Paid $10.00 119704 3/16/12

104 IA Provider 7 Child Care 2/28/12 2/28/12 3/2/12 Paid $13.00 119476 3/2/12

104 IA Provider 7 Child Care 3/13/12 3/13/12 3/16/12 Paid $13.00 119704 3/16/12
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 11

identification of a real or potential issue to a provider, 

provider review and justification, technical assistance 

if needed, and ongoing monitoring until the issue is 

fully resolved.

Lessons

Iowa ATR’s Claims Reconciliation Tool is used to monitor client choice of available recovery support services. 

Many of Iowa ATR’s providers offer both care coordination and a wide variety of recovery support services. 

By regularly reviewing the Claims Reconciliation Tool,

the project director can review all of the clients admitted by an agency along with all of the services each 

client has received. If the project director notices high 

utilization by a provider of a specific service compared 

to the provider network average, this may be cause 

for ATR staff to investigate. This specific example was 

offered by Iowa ATR’s project director: 

“ Provider A” offers care coordination, drug testing, and life skills coaching. From the review of 

the Claims Reconciliation report, I see that every 

one of the 27 clients Provider A has admitted into 

ATR has received life skills coaching, resulting 

in a 100% utilization rate for this service. I can 

then compare this to the utilization rate for the 

entire provider network, which is 26%. Further 

investigation into the VMS reveals that none of the 

clients seen by Provider A have received an outside 

referral for any other recovery support services. 

The concern is, are clients being offered choice, or 

are they only being offered services provided by 

Provider A? To determine this, an investigation 

takes place, which would likely include an e-mail 

and a site visit.

Area 4: Rates

ATR’s utilization of a client voucher to fund clinical 

and recovery support services provided by culturally 

based and faith-based organizations is a unique feature of this grant. ATR’s recognition of the vital role of 

recovery support services in helping persons maintain 

recovery is groundbreaking and effectively changes 

the status of these services from “ancillary-to-clinical” 

to core services that enhance treatment outcomes. 

Many of these recovery support services are provided 

by organizations that operate outside of the traditional 

system of substance abuse services. Inclusion of these 

service and provider options raises several implementation issues for ATR project staff, including the setting 

of rates for these services. While grantees utilized 

several methods to set initial rates for these services, 

ATR project staff have developed VMS data-generated 

reports that allow ATR project directors to review the 

current array of services and adjust factors, such as 

service mix and rates, when deemed appropriate. 

Washington State ATR provides a sample spreadsheet 

and report they use to review and monitor their ATR 

project service array. 

Purpose and Importance

Washington State ATR’s Spending by Service Type 

and County Report is generated monthly. (The sample 

on the following page represents a project year.) The 

report allows the project director to review spending 

patterns for all ATR-financed services and compare 

this spending by county. This report can also be generated at the provider level, affording ATR management 

an additional view of these data.

In addition to providing a continuous view of the 

utilization of ATR services in Washington, this tool 

enables the project director to pinpoint both highly 

utilized and underutilized recovery support services. It 

also helps the project director to work with ATR staff, 

counties, and providers to identify the reasons for 

these utilization patterns, which can potentially result 

in rate and service mix adjustments.

Report Elements and Use

Data elements of the Washington State ATR Spending 

by Service Type and County Report include services by 

type, percentage of total spending on each service by 

type, total dollars spent project-wide on each service 

type, and county-by-county spending on each service 

type. Washington State ATR’s monthly report, shown 

on page 13, provides the ATR project director with a 

view of total project spending by service category.
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 12

Washington State ATR Spending by Service Type and County by Project Year

Service Description Total County 1 County 2 County 3 County 4 County 5 County 6

Alcohol and Drug Information 

School

0.0% $ 422.92 $ 75.00 $ 347.92 

Alcohol and Drug-Free Social 

Activities

0.0% $ 1,645.60 $ 1,645.60 

ATR Voucher Number check/

setup

0.0% $ - 

Brief Intervention 0.2% $ 9,900.00 $ 9,900.00 

Child Care 0.0% $ 520.00 $ 520.00 

Employment Coaching 0.0% $ - 

Family Services 0.6% $ 24,231.04 $ 900.00 $ 23,331.04 

Family/Marriage Counseling 0.0% $ - 

Group Mental Health Services 0.0% $ - 

Housing Support 30.5% $ 1,240,434.74 $ 259,868.13 $ 457,230.00 $ 252,613.53 $ 11,118.98 $ 259,604.10 

Individual Mental Health 

Services

0.0% $ - 

Information and Referral 9.3% $ 377,622.63 $ 163,010.00 $ 73,236.00 $ 107,126.63 $ 24,500.00 $ 9,750.00 

Initial GPRA Interview 0.0% $ - 

Intake Processing 0.9% $ 35,800.00 $ 35,800.00 

Medical Care (Primary) 12.4% $ 502,638.87 $ 351,425.00 $ 94,567.97 $ 619.90 $ 28,586.25 $ 27,439.75 

Mental Health Assessment 0.0% $ 355.38 $ 355.38 

Other Clinical Services 0.7% $ 29,458.18 $ 5,360.00 $ 1,705.88 $ 3,815.03 $ 18,577.27 

Other Education Services 0.9% $ 38,199.21 $ 24,640.00 $ 11,208.24 $ 230.02 $ 472.95 $ 1,648.00 

Other Medical Services 1.6% $ 64,885.88 $ 3,455.50 $ 39,698.20 $ 21,732.18 

Other Peer to Peer Services 0.0% $ 24,450.00 $ 24,450.00 

Other Recovery Services 16.1% $ 656,453.14 $ 68,753.53 $ 171,925.40 $ 230,757.90 $ 185,016.31 

Peer Coaching or Mentoring 0.2% $ 9,550.00 $ 9,550.00 

Pharmacological Interventions 0.1% $ 2,369.09 $ 993.78 $ 1,375.31 

Pre-employment Services 1.7% $ 70,396.02 $ 1,188.80 $ 68,989.22 $ 218.00 

Psych Evaluation 0.0% $ - 

RSS 9.8% $ 397,644.83 $ 141,456.83 $ 123,188.00 $ 133,000.00 

Self-Help and Support Groups 0.0% $ - 

Spiritual Support 1.4% $ 55,200.00 $ 55,200.00 

Standard TB Testing 0.0% $ - 

Supportive Transitional DrugFree Housing6.2% $ 251,674.29 $ 31,783.00 $ 219,891.29 

Transportation 6.7% $ 271,502.06 $ 737.00 $ 24,064.45 $ 59,111.82 $ 78,405.68 $ 109,183.11 

Urine Analysis (UA) 0.0% $ 100.00 $ 80.00 $ 20.00 

TOTAL 100.0% $ 4,065,453.88 $ 885,665.13 $ 598,686.83 $ 598,095.04 $ 455,702.17 $ 758,885.30 $ 768,419.41

Services where

expenditures >=10%

78.1% $ 2,672,155.34

4.4% 11.4%
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 13

Initial Screening

Alcohol and Drug Information School

Urine Analysis (UA)

Mental Health Assesment

Child Care

Alcohol and Drug-Free Social Activities

Pharmacological Interventions

Peer Coaching or Mentoring

Brief Intervention

Family Services

Other Peer to Peer Services

Other Clinical Services

Intake Processing

Other Education Services

Spiritual Support

Other Medical Services

Pre-employment Services

Supportive Transitional Drug-Free Housing

Transportation 

Information and Referral

RSS

Medical Care (Primary)

Other Recovery Services

Housing Support

$0 $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000

$0

$75

$100

$355

$520

$1,994

$9,550

$2,369

$9,900

$24,231

$24,450

$29,458

$35,800

$38,199

$55,200

$64,886

$70,396

$251,674

$271,502

$377,623

$397,645

$502,639

$656,453

$1,240,435

Utilizing the Spending by Service Type and County 

Report, Washington State ATR staff can monitor utilization of services by county and use this information 

to further investigate the reasons for these utilization patterns. For example, Other Recovery Services 

account for just over 16% of total ATR spending, the 

second highest category. Review of county-level information reveals that this spending occurred primarily 

in three of the six ATR project counties. Spending 

trends, such as this example, can then be discussed 

among the ATR management team and investigated 

for further appropriate resolution, including possible 

changes in rates and adjustment to approved service 

mixes.

Lessons

Review and analysis of the data contained in 

Washington State ATR’s Spending by Service Type 

and County Report provides ATR staff with critical 

service utilization information as part of their assessment of the quality and effectiveness of the State’s 

model and providers and allows Washington ATR staff 

to assist providers in targeting areas for improvement. 

Washington State ATR’s project director notes:

By monitoring service utilization and upon further 

investigation of these patterns during ATR 1 and 

2, Washington State ATR has decided to limit case 

management fees to 30% of client voucher totals 

Washington State ATR Spending by Service
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 14

(in the aggregate) during ATR 3. This strategy has 

been implemented to assure ATR funding for other 

key voucher-purchased recovery support services 

(such as housing and other recovery support 

services) that are critical to supporting a client’s 

unique recovery needs. This change in service 

mix allows Washington State ATR to continue to 

reimburse for highly utilized services at competitive 

rates to assure ATR clients access to these services. 

Other project directors interviewed for this package 

note that, in their programs, service utilization data 

contained in reports similar to Washington State ATR’s 

Spending by Service Type and County Report have led 

to changes in ATR service rates. One project director 

noted that by monitoring service utilization in his project, and upon further investigation, housing support 

rates were increased to the local fair market rate to 

assure that ATR clients could access community housing opportunities. 

Area 5: Fraud, Waste, and Abuse

Successful ATR grantees are required to “maintain 

accountability by creating an incentive system for positive outcomes and taking active steps to prevent waste, 

fraud, and abuse” (TI10-008, Access to Recovery, 

Request	for	Application,	SAMHSA,	2010).	Potential	

grantees have to describe their procedures as well as 

the concrete steps that will be implemented as part of 

their voucher management system to prevent waste, 

fraud, and abuse. 

Missouri ATR provides an example of the report and 

process they use to identify, remediate, and monitor 

for potential instances of fraud, waste, and abuse.

Purpose and Importance

Missouri ATR’s system to prevent fraud, waste, and 

abuse has evolved through ATR 1 and 2, with key 

VMS enhancements in ATR 3 based on lessons learned 

during the previous grant cycles. While fraud, waste, 

and abuse efforts were mainly focused on periodic, 

onsite monitoring by ATR staff to detect and correct 

these instances during the first two grant cycles, the 

present electronic documentation and billing system in 

ATR 3 includes numerous validation checks at the time 

the contracted provider enters billing information into 

the system, thereby preventing inappropriate activity 

from occurring. Specifically, these validation checks 

include:

•	 The	client	and	staff	cannot	be	engaged	in	more	than	

one ATR billable service at the same time. 

•	 Services	delivered	and	billed	are	tied	to	a	preapproved ATR staff member.

•	 Each	electronic	voucher	is	checked	to	ensure	that	

the service and unit are available to the client before 

billing can be entered into the system. 

•	 Documentation	is	entered	into	the	electronic	billing	

system, allowing ATR project management staff to 

review it for appropriateness without making a site 

visit to the provider.

Even with these VMS rules in place, a report such as 

Missouri ATR’s Recovery Support Average Cost Report

can help detect and prevent waste, fraud, and abuse 

by revealing patterns that may indicate inappropriate 

service delivery and/or billing that requires a closer 

examination to determine if an actual problem exists. 

Report Elements and Use

Missouri ATR’s Recovery Support Average Cost Report

contains the number of clients served by each agency 

and the average, median, minimum, and maximum 

costs per client for the report time period, which can 

be viewed in any time period (e.g., monthly, to date). 

Using this report, ATR management staff can compare 

costs across providers and quickly identify providers 

whose average per-client costs are significantly higher 

than other providers’ averages, or whose maximum client costs greatly exceed the average per-client cost. 

Examples of these patterns are highlighted in yellow 

in the report on the following page. Note that RSS 

Providers 2 and 4 in ABC City have similar average 

client costs but significantly different maximum costs. 

The	average	client	cost	at	Housing	Provider	2	in	the	

Southwest	Region	is	double	that	of	Housing	Provider	3,	

while having nearly identical client maximum costs. 
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 15

ATR 3: Recovery Support Average Cost Project Year to Date

Area Agency # Consumers Average Cost Median Cost Minimum Cost Maximum Cost

STATEWIDE 2,779 $397 $317 $5 $1,240

ABC CITY 1,441 $352 $276 $5 $1,194

Housing Support 1 9 $351 $333 $28 $740

Housing Support 2 103 $445 $305 $85 $1,035

RSS Provider 1 88 $136 $138 $10 $188

RSS Provider 2 30 $324 $323 $12 $845

RSS Provider 3 65 $456 $396 $40 $1,027

Housing Support 3 1,417 $197 $118 $5 $834

RSS Provider 4 35 $257 $268 $18 $488

RSS Provider 5 58 $142 $92 $5 $815

Housing Support 4 103 $529 $499 $55 $992

RSS Provider 6 40 $479 $360 $40 $1,060

Housing Support 5 29 $527 $480 $140 $1,035

Housing Support 6 33 $606 $551 $70 $1,031

RSS Provider 7 8 $122 $114 $28 $220

SOUTHEAST 209 $500 $440 $8 $1,224

RSS Provider 1 40 $652 $644 $120 $1,186

Housing Support 1 22 $537 $576 $60 $1,036

RSS Provider 2 161 $350 $190 $24 $1,224

RSS Provider 3 4 $215 $170 $58 $462

Housing Support 2 10 $731 $542 $485 $1,069

RSS Provider 4 9 $224 $96 $8 $792

SOUTHWEST 655 $458 $412 $14 $1,240

Housing Support 1 76 $409 $384 $16 $1,044

Housing Support 2 17 $843 $966 $96 $1,116

RSS Provider 1 107 $467 $449 $18 $1,013

RSS Provider 2 22 $388 $308 $8 $1,074

Housing Support 3 28 $421 $368 $40 $1,016

RSS Provider 3 634 $157 $108 $20 $1,216

RSS Provider 4 108 $288 $206 $12 $1,044

RSS Provider 5 5 $170 $256 $16 $288

RSS Provider 6 11 $370 $390 $15 $645

Housing Support 4 82 $302 $316 $12 $808

Housing Support 5 35 $543 $540 $24 $1,040

RSS Provider 7 19 $283 $224 $18 $767

WEST CENTRAL 480 $400 $313 $5 $1,236

RSS Provider 1 28 $92 $58 $10 $290

RSS Provider 2 3 $233 $50 $33 $616

RSS Provider 3 6 $60 $45 $28 $135

Housing Support 1 87 $288 $228 $10 $910

Housing Support 2 476 $343 $227 $5 $1,236

Notes: These statistics are based on paid claims hitting the ATR 3 payer plan. They are based on those with redeemed services.
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 16

Once patterns such as these are identified, they can 

lead to further investigation of the provider and trigger 

questions that often uncover the presence of fraud, 

waste, or abuse, such as:

•	 Does	the	provider	bill	the	same	pattern	of	services	

for each client? 

•	 Does	each	service	billed	start	and	end	exactly	on	the	

hour? 

Lessons

While Missouri ATR has invested significant time 

and effort in mechanisms designed to prevent waste, 

fraud, and abuse from happening in the first place, the 

Recovery Support Average Cost Report provides the 

ATR team with a continual window to quickly spot 

billing patterns requiring further review. The project 

director notes that, during ATR 2, information obtained 

from this report and subsequent field investigations 

resulted in increased monitoring and coaching of a 

particular provider to prevent waste, fraud, and abuse. 

One result is that under ATR 3, the Missouri ATR team 

installed caps on the maximum amount of recovery 

support services billable per consumer per week. These 

caps are designed to encourage longer episodes of care 

by limiting the amount of funds available for services 

in any given week while reducing the potential for 

inappropriate service delivery, especially during the 

early weeks of an ATR client’s enrollment in services.

Given Missouri’s long experience as a three-time ATR 

grantee, the project director shared this final example 

of the critical role data play in monitoring providers for 

waste, fraud, and abuse. 

During ATR 1, the Missouri ATR Team noticed one 

provider had an extremely high follow-up GPRA 

rate. This provider was responsible for a large 

number of follow-up GPRA consumer interviews. 

Their percentage of follow-up GPRAs collected 

remained 99% to 100%. The data led the ATR 

team to ask the provider staff if they understood 

and were following all the rules regarding followup GPRAs, and they indicated they were. However, 

when asked to explain the methods they used to 

obtain their remarkable results, they were unable to 

articulate sophisticated client tracking and followup methods. The ATR team then conducted an 

onsite investigation and eventually one of the staff 

members admitted clients were not being interviewed and the follow-up GPRA data were being 

falsified. This led to recoupment of fees paid and 

discontinuation of our business agreement with this 

organization.

Area 6: Client Profiles and Client Outcomes

The ATR grant requirement to implement a VMS 

that tracks multiple data elements regarding clients, 

services, and providers affords grantees a broad and 

deep pool of information about individual clients that 

is unmatched in traditional substance abuse service 

systems. Access to this database enables ATR grantees 

to report on client service profiles and client outcomes 

in both great depth and breadth. 

The	Anishnaabek	Healing	Circle	Access	to	Recovery	

Inter-Tribal Council of Michigan (ITC-MI) provides a 

sample of its Provider Report Cards based on general 

data as an example. 

Sample Tribe ATR Access Site Outcome Report 

Second	Quarter	

(January	to	March,	2010,	and	Year	to	Date,	October	2009	to	

March	2010)

45%

86%

42%

75%

91%

67% 70%

92%

50%

86% 91%

63%

0%

20%

40%

60%

80%

100%

Intake

6 Months

* Abstinent

* Arrest-Free

Employed/In School

* No HBSC

* Socially Connected

Stable Housing

Sample Tribe A: Cumulative through Mar 2010

GPRA Measures at Intake & 6 Month Follow Up Sample Tribe A: Cumulative through March 2010 

GPRA Measures at Intake & 6-Month Follow-Up
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 17

The Provider Report Card offers a simple look at 

clients’ individual outcomes by comparing changes in 

key client outcome areas at intake and again at followup. ITC-MI ATR staff also provide an analysis to each 

provider indicating if these changes are statistically 

significant, which often occurs.

Purpose and Importance

The ITC-MI ATR project director notes:

Beginning in the third year into ATR 2, we started to 

look at client outcomes, such as the GPRA outcomes 

(i.e., abstinence, arrest rate, employment, health and 

behavioral consequences, social connectedness, and 

housing). As a first step, we started looking at them 

overall globally, as well as by provider. Our goal 

of implementing recovery-oriented systems of care 

is based on other people’s evidence (i.e., evidence 

based on cultures and populations outside of local 

Native American communities) or the notion that 

persons with substance use disorders are suffering 

from a chronic long-term illness which requires 

services beyond episodes of acute care. Our project 

is predicated on the principle that offering a wider 

array of long-term services at low cost after a person 

completes clinical services can support long-term 

recovery; report cards are a first step in providing 

empirical evidence.

Report Elements and Use

The ITC-MI ATR Provider Report Cards include key 

graphs, such as the GPRA Outcome Measures: Change 

from Intake to 6-Month Follow-up. This chart contains client assessment data for six key GPRA outcome 

measures, which is aggregated and averaged from the 

intake and 6-month follow-up interviews. These six 

key areas include: 1) abstinence, 2) criminal justice 

involvement (arrest-free), 3) employment or in-school 

status, 4) experience of no substance-use-related 

health,	behavioral,	or	social	consequences	(HBSC),	5)	

social connections, and 6) stable housing. The graph 

on page 16 represents sample tribe clients who, as a 

group, showed statistically significant improvement 

between intake and follow-up for four out of the six 

measures. Social connectedness did not change, and 

stable housing showed a small decline. 

ITC-MI ATR’s staff also calculate an aggregate change 

rate for each ATR tribal participant and provide a comparison between the individual tribe’s change rate and 

the overall ATR project. This information is displayed 

in the “Change Rate: GPRA Outcomes” section of 

ITC-MI ATR’s Provider Report Cards. The change rate 

reflects how much improvement was made between 

intake and follow-up. In the example on this page, 

46% more sample tribe clients reported abstinence at 

the 6-month follow-up than did at intake. The gain (or 

loss) in the percentage is compared to all Michigan 

tribal ATR clients combined. As the chart shows, the 

change rate for sample tribe clients was greater than 

the change among all Michigan tribal ATR clients for 

four of the six measures, with abstinence showing the 

biggest improvement rate compared to all Michigan 

tribal ATR clients.

ITC-MI ATR’s project director reports that use of 

Provider Report Cards has allowed for the identification of providers that have outcomes below the overall 

average and of other providers that are significantly 

above it. ITC-MI ATR staff are then able to talk with 

providers and identify differences that may contribute 

to the achievement of better client outcomes. From 

these inquiries, ITC-MI ATR is developing another set 

of questions designed to better capture the relationship between service array and outcome. Additionally, 

ITC-MI ATR staff can provide technical assistance 

to providers whose outcomes are below average and 

share successful strategies used by other providers 

discovered through the report card process.

-20%

-10%

0%

10%

20%

30%

40%

50%

Change Rate: GPRA Outcomes

Sample Tribe B Compared to Michigan ATR Tribal Sites

Sample Tribe All MI ATR Trible States

 Abstinent

 Arrest-Free

Employed/In School

 No HBSC

 Socially Connected

Stable Housing

46%

30%

7% 5%

19%

2%

13%

5.5%

13%

-10% 1%

Change Rate: GPRA Outcomes 

Sample Tribe B Compared to Michigan ATR Tribal Sites

Sample Tribe All MI ATR Tribal States
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 18

Lessons

ITC-MI ATR staff note that although it was possible to 

produce program outcomes in the past, these outcomes 

could not be associated with a particular service array, 

dosage, or cost, nor further associated with severity or 

type of substance abuse at intake. The highly detailed 

data available through the VMS and GPRA data sets in 

ATR are changing that. ITC MI ATR’s Provider Report 

Cards are the first step toward planned outcome studies to determine the most powerful configuration of 

clinical and recovery services that produce the best 

outcomes for various types and severities of substance 

abuse indicators. 

ITC-MI ATR also plans to explore the correlation 

between cost and outcomes, service array and outcomes, and dosage of services and outcomes. The 

availability of this information makes it possible to 

test the assumption that someone receiving higher 

frequency and intensity of services will have better 

outcomes than someone with lower frequency and 

intensity of the same service. Such evidence will drive 

expenditures in future ATR cohorts.

Area 7: Care Coordination 

Grantees in the third cohort of ATR are required to 

incorporate care coordination into their projects to 

ensure that following the receipt of vouchers, clients 

receive appropriate and effective clinical treatment 

and/or the recovery support services of their choosing. 

While ATR grantees have implemented various models of care coordination, a common element includes 

helping ATR enrollees “identify their needs and choose 

appropriate services within collaborating systems of 

care” (TA Package on Care Coordination).

ATR grantees use a variety of reports based on VMS 

and GPRA data to assure appropriate implementation 

of their care coordination model. An example of these 

reports and of the process is provided by the Indiana 

ATR project.

Purpose and Importance

Care coordination agencies certified by Indiana ATR work 

with a full range of medical and support services that 

are offered from within and outside the managed care 

plan and that arrange services that are both covered and 

not covered. Indiana ATR uses a community-based care 

coordination model, which certifies three to five agencies 

in each county to deliver person-centered services to 

clients from intake to discharge. These agencies range 

from small to large and have a variety of specialty areas 

and approaches, which makes using management tools 

that reveal trends at the agency level crucial. Care 

coordinators are expected to:

•	 Engage	and	retain	clients.

•	 Provide	clients	with	an	appropriate	service	mix	

based on their strengths and needs, including assistance with eligibility and application for services 

from various agencies that will be beneficial to the 

client’s overall health and wellness (including services not funded by ATR).

•	 	Collect	data	on	client	progress	at	intake,	follow-up,	

and discharge.

Report Elements and Use

The Indiana ATR State project team uses several VMS 

reports to track whether care coordination agencies are 

meeting their goals. These reports are created by the 

Indiana ATR database manager using information collected in the Web Infrastructure for Treatment Services 

(WITS) system. The database manager created a 

password-protected Reports Manager site where all 

Indiana ATR program management reports are housed, 

allowing the State project team to access real-time data 

when desired. The primary reports used to manage 

care coordination include:

Dashboard—Run weekly, the dashboard provides the 

Indiana ATR team with a State-level view of project 

activity. As it relates to care coordination, this report 

provides important information regarding provider 

certification, service mix, weekly enrollments, and 

weekly expenditures. With a community-based care 

coordination model, Indiana ATR must track this 

information closely to effectively project burn rate and, 

as needed, work with agencies to assess and address 

capacity issues.

6-Month Follow-Up—Indiana ATR policy states that 

agencies must maintain a follow-up rate of 80% or 
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 19

higher in order to continue enrolling clients. This 

report—a sample of which is provided on this page—is 

reviewed at weekly project team meetings, and a plan 

is created for agencies not meeting Indiana ATR standards. Additionally, agencies maintaining a follow-up 

rate of 85% or higher are awarded a small incentive 

per	follow-up	interview.	Having	this	agency-specific	

report readily accessible allows the Indiana ATR team 

to quickly address issues with follow-up rate and 

incentivize high-performing providers.

Non-Funded Referrals—With the limited resources 

available per client through the Indiana ATR grant, 

a priority and expectation for care coordinators is 

to connect clients to services that are not funded by 

Indiana ATR. As a management and sustainability 

tool, Indiana ATR recently began tracking informal 

referrals to support services that are not grant-funded. 

This biweekly report summarizes those non-funded 

referrals. Each non-funded service can be expanded 

to reveal the list of agencies that referred clients. 

This information allows regional project managers to 

provide technical assistance to underperforming care 

coordination agencies. 

Report Card—Although dashboard reports are keys 

to managing State-level performance, Indiana ATR 

finds it useful to regularly access agency-level data to 

inform training and technical assistance initiatives. 

The report card report was developed recently to track 

key variables for care coordination agencies, including 

average engagement length, average time to bill, average cost per client, average number of Indiana ATR 

agency referrals, and key GPRA outcome measures. 

These reports are distributed to each care coordination agency quarterly, allowing the agency to track 

their progress on meeting program goals and to make 

adjustments as needed. These reports also support 

the important work the care coordination agencies are 

doing in grant proposals, newsletters, presentations, 

and the like.

Lessons

Indiana ATR has learned that to effectively manage 

care coordination agencies, VMS reports must be 

tailored to track the specific goals and expectations set 

out in policy documents. Additionally, while understanding the State-level perspective is important, VMS 

reports should take certain data elements down to 

agency level so that technical assistance and training 

efforts are focused and the effectiveness of those interventions can be tracked. 

Part 3: References and Additional Resources 

The ATR Implementation Toolkit consists of three 

workbooks,	prepared	by	SAMHSA,	to	be	used	as	

planning, implementation, and operational tools for 

ATR programs. The Toolkit may assist Single State 

Authority and tribal program officials and their ATR 

project teams (http://atr.samhsa.gov/ATR3resources.

aspx). 

6-Month Follow-Up Report

Agency 

Name

Due Today or 

Before

Compliant 

Follow-up Percent Missing GPRAs

RC-1 0 1 -1

RC-2 57 65 114.04% -8

RC-3 131 137 104.58% -6

RC-4 53 55 103.77% -2

RC-5 143 143 100.00% 0

RC-6 83 82 98.80% 1

RC-7 128 125 97.66% 3

RC-8 111 107 96.40% 4

RC-9 42 39 92.86% 3

RC-10 107 98 91.59% 9

RC-11 127 116 91.34% 11

RC-12 344 307 89.24% 37

RC-13 95 84 88.42% 11

RC-14 48 41 85.42% 7

RC-15 2 1 50.00% 1

RC-16 4 2 50.00% 2

RC-17 12 4 33.33% 8

RC-18 10 2 20.00% 8

RC-19 4 0 0.00% 4

RC-20 0 0 0

RC-21 0 0 0

RC-22 0 0 0

RC-23 0 0 0

RC-24 0 0 0

Totals: 1501 1409 93.87%
SAMHSA TECHNICAL ASSISTANCE PACKAGE

Grantee Experience: Voucher Management Systems as a Program and Financial Management Tool 20

ATR Grantee Contact Information for the seven project directors who graciously contributed their reports, 

examples, and expertise to this package is included as 

Appendix A.

Webinar Grantee Tools: VMS as a Program and 

Financial Management Tool broadly defines key 

concepts of data-driven decision making and continuous quality improvement and identifies a report 

development process. Selected grantees’ reports are 

showcased, including background information on the 

purpose for and process used to develop these reports. 

(Presented March 15, 2012)

Appendix A

ATR TA Package: Grantee Experiences: Using the 

VMS as a Program and Financial Management Tool 

Contributors	List	

April Schmid, MPA 

Project Director

Indiana Access to Recovery

Division	of	Mental	Health	and	Addiction	

Family and Social Services Administration

402 W. Washington St., Room W353 

Indianapolis, IN 46204 

(317) 234-5555 (O) 

Eva	L.	Petoskey,	MS

Director,	Anishnaabek	Healing	Circle	

Access to Recovery

Inter-Tribal Council of Michigan

2956 Ashmun St.

Sault St. Marie, MI 49783

(231) 357-4886

epetoskey@itcmi.org

epetoskey@centurytel.net 

Alternate Mailing Address:

2848 N. Setterbo Road

Peshawbestown, MI 49682

Alisia Clark

ATR Project Director

Ohio Department of Alcohol and Drug Addiction 

Services

30 W. Spring St., 6th floor

Columbus,	OH	43215

(216) 970-3988

(614) 644-8428

Fax: (614) 728-8031

Vince Collins, MSW

ATR Project Director

Division	of	Behavioral	Health	and	Recovery

P.O. Box 45330 

Olympia, WA 98504

(360) 725-3713

vince.collins@dshs.wa.gov

Robert Gurule

ATR Project Director

New	Mexico	Human	Services	Department

Behavioral	Health	Services	Division

37	Plaza	La	Prensa

Santa Fe, NM 87502

(505) 476-9278 

Mark	R	Shields,	MEd,	LPC,	CRAADC

ATR Project Director

Missouri Division of Alcohol and Drug Abuse and 

Psychiatric Services

1706 East Elm St.

P.O. Box 687

Jefferson City, MO 65102

(573) 751-4942

Fax: (573) 751-7814

mark.shields@dmh.mo.gov

Kevin	M.	Gabbert,	LISW,	IAADC

ATR Project Director

Iowa	Department	of	Public	Health

Division	of	Behavioral	Health	

321 E. 12th St.

Des Moines, IA 50319

(515) 281-7080 

kevin.gabbert@idph.iowa.gov