The Centers for Medicare & Medicaid Services (CMS) has announced the 61 providers that it has chosen to participate in its new Value in Opioid Use Disorder (OUD) Treatment Demonstration.
Starting this month, the four-year demonstration will test whether a new care management fee and performance-based incentive for OUD treatment can reduce hospitalizations and improve outcomes for Medicare beneficiaries.
The demonstration creates two new Medicare payments for program participants, which include a per beneficiary, per month care management fee and a performance-based incentive payment. Providers in the program can use the reimbursements for non-clinical, patient-centered OUD treatment services not currently covered by Medicare, which is exempt from parity requirements and thus typically leaves many behavioral health treatment options unavailable to beneficiaries.
The goal of the demonstration is to increase beneficiaries’ access to OUD services and improve mental and physical health outcomes, while also cutting Medicare expenditures.
Those selected to participate in the program include physicians, hospitals, health centers, SUD treatment providers across 37 states, according to CMS. Among the most well known SUD providers selected to participate is BayMark Health Services, one of the largest medication-assisted treatment (MAT) providers in the nation.
In fact, CMS picked four BayMark programs to participate: BayMark Health Services of Louisiana; BayMark Health Services of Utah; BayMark Health Services of Colorado; and BayMark Health Services of Alabama.
Headquartered in Lewisville, Texas, BayMark has more than 250 clinics across the US and Canada. It’s offerings include outpatient and residential care, detox services and office-based opioid treatment programs (OTPs). The company is owned by Webster Equity Partners.
CMS also selected three Eleanor Health programs for the value-based care demonstration — one in North Carolina, one in New Jersey and one in Massachusetts. Eleanor Health recently connected with Behavioral Health Business to discuss its value-based care strategy.
“When we think about how we try to partner with payers, it’s really on a longitudinal payment construct that pays us for our ability to engage, treat, get high quality outcomes and reduce the total cost of care for patients,” Corbin Petro, CEO and co-founder of Eleanor Health, told BHB at the time.
Eleanor Health provides comprehensive SUD treatment built around value-based care in six states. It addresses SUD, as well as the co-occurring psychiatric, physical and social issues that come with it.
You can read more about CMS’s Value in OUD Treatment Demonstration and find the full list of selected participants here.