Value-Based Care is the Future, Says Caron Treatment Centers CEO

Brad Sorte, CEO, and president of Caron Treatment Centers, sees his organization striving toward greater sophistication through research as it fully embraces the shift to value-based care.

Those moves prepare the Wernersville, Pennsylvania-based addiction treatment provider for success in a behavioral health industry where a top, hot-button issue is the move away from fee-for-service arrangements with insurers to value-based care.

And as it takes on risk through tying reimbursement to outcomes, Caron Treatment Centers — a nonprofit incorporated as the Richard J. Caron Foundation — seeks to increase its own capabilities to care for those battling addiction and other behavioral health issues.  

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Sorte became CEO of Caron in July, replacing long-time Caron leader Doug Tieman.

When asked if the future of Caron’s payor relationships will continue to break with the fee-fee-for-service model indefinitely into the future, Sorte said, “That’s a great way to frame it.”

“The mantra was are trying to champion here, not just for Caron but for anybody. The adversarial posture between provider and payer doesn’t have to be the standard. We would advocate for the most beneficial approach, which is a collaborative partnership between the payer and the provider where both sides are willing to take risks.”

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For the last several years, Caron has been on an inexorable journey toward driving value into its practices. The focus on value in addiction treatment extends beyond just the type of contracts Caron has with payers. For Sorte and Caron, this means pushing the science of addiction treatment forward.

“We are really tired of being in the Dark Ages, to some degree, as it relates to the innovations that much of the rest of medicine has seen in the treatment of chronic illnesses,” Sorte said. “By thrusting into research in a very practical setting — which is what is very innovative about our research center — we’re hoping to rapidly advance those initiatives in the years to come.”

In July, Caron’s Chief Medical Officer Joseph Garbely told Behavioral Health Business that it would establish the Fran and Doug Tieman Center for Research on its flagship and headquarter campus in Wernersville. By doing so, Caron is taking its “moonshot” by trying to change the subjective nature of the addiction treatment field.

Sorte clearly has high hopes for the research center. He hinted at big things to come from the center but declined to get specific about it.

“We are going to be coming out with something in 2022 from our research center that is going to really be a game-changer,” Sorte said. “That’s all I can say.”

The company will also open a 100,000-square-foot medical center called the Keele Center at its Boca Raton, Florida location in December 2022 that will offer 22 residential beds, eight residential suites for the Caron Ocean Drive program, 10 supervision and detox beds, and will act as a training site for new providers.

Investments into technology to track outcomes

The investment into research comes in a similar vein of innovation as to the company’s effort to better deploy technology to provide it better infrastructure.

Presently, the company is trying to work out affordability and efficiency questions behind its My First Year alumni program. Sorte said it’s vital for organizations to have “a good mechanism and apparatus” to track the progress of people post-care.

My First Year is patterned after the successful Physicians’ Health Program, an addiction recovery program for doctors. My First Year incorporates coaching, random screenings and participation in support groups.

It also uses video conferencing with Caron staff, alumni and family members to help support people after completing treatment at Caron.

Starting in November 2012, My First Year has since supported 1,335 patients and 1,747 family members.

The program so far has been successful with around 75% of participants reaching a year of sustained abstinence. Proving impact and measuring care improvements are a vital part of many value-based care contracts.

“If you have tools like that … we know that we can give people a really good probability of having a great outcome,” Sorte said. “I think that platform from our perspective is a great innovation. Now our initiative is really how do we make it so that every patient gets to take it home with them.”

Moving towards value based care with a pilot

The push toward value-based care also helps debunk a frequent narrative that surrounds addiction treatment, Sorte said: that people suffering from addiction have a low probability of reaching recovery.

Caron touted the success of the value-based care arrangement that it has with Philadelphia-based Independence Blue Cross, an independent licensee of the Blue Cross and Blue Shield Association. Caron executives presented those outcomes at the Rx Drug Abuse & Heroin Summit in April.

In 2017, Caron and Independence Blue Cross (IBC) entered into an arrangement where IBC would pay Caron a flat fee to treat IBC members and cover any readmission within 90 days of discharge from an addiction care facility. This was a pilot program born out of a deal struck between Caron’s then-CEO Doug Tieman and IBC’s then-CEO Dan Hilferty.

“That was done as a pilot program because Dan had asked Doug how he could get IBC’s patients to come to Caron,” Sorte said. “If IBC would eliminate the managed care part, and [Caron and IBC] could meet in the middle on a rate that was livable for IBC —and actually compensated Caron for the type of care that we would provide — we’d be willing to take some risk on that.”

In 2019, Caron’s readmission rate was 5.6% at 90 days, according to data Caron released at the addiction summit. Sorte said in the interview the retreatment rate for IBC members was about 18% after a year. Caron treated 71 IBC members.

In the same period, 645 IBC members received addiction treatment from six other network providers which posted 90-day readmission rates that ranged from 11.6% to 25.7%

Sorte pointed to the IBC arrangement as an example of why he champions for better relationships between providers and payers: the more payers and providers collaborate around value, the better outcomes get for all stakeholders. The 2017 deal was also the impetus for the company’s embrace of value-based care.

He said that after establishing value-based care contracts with IBC, it began to roll out similar contracts with other payers, most notably other Blue Cross entities and Hartford, Connecticut-based Aetna Inc., now part of CVS Health.

This embrace with the latest in payer arrangements is a stark contrast with Caron’s recent past. As recently as five years ago, Caron was “private pay, out of network,” Sorte said. The organization changed its approach after various stakeholders complained about Caron not being accessible during a previous strategic planning process.

“Again, [value-based care] puts the onus on the provider to raise their standard of care,” Sorte said. “But the long-term effect of raising the standard of care will eventually be better outcomes for the patient, lower costs for the payer, and hopefully, better reimbursement.”

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