Eleanor Health
Founded in 2019, Eleanor Health is an addiction treatment provider based out of Waltham, Massachusetts. It was one of the 61 providers chosen for CMS’s New Value-Based OUD Treatment Demonstration in 2021. Since then, Eleanor health has received numerous funding rounds from pursuing its value-based care platform, with the most recent financing being $50 million in April of 2022.
The company has partnered with Point32Health and Amerigroup Washington to deliver Value-Based Care to its addiction and mental health patients. Eleanor currently provides care in six states with 28 clinics.
Working with payers is critical in Eleanor Health’s value-based care model.
“When we go to payers and talk to them about a population-based approach, we come with the data that we have achieved in our care model; we come with quality outcomes, access outcomes, satisfaction outcomes, and cost outcomes,” Corbin Petro, CEO and co-founder of Eleanor Health, said during a panel at the Behavioral Health Business VALUE conference. “So our ability to reduce the total cost of care, improve quality, and retain folks in care has led us to have great … value-based partnerships with payers.”
Groups Recover Together
Burlington, Massachusetts-headquartered Groups Recover Together was founded in 2014. Groups treat opioid use disorder (OUD) patients, currently in 15 states and expanding to 9 more states. Groups scored a $60 million last year in series C funding to expand its service offerings nationwide.
Groups’ business is performance-based rather than private pay or fee-for-service models.
“Groups Recover Together sees six-month retention rates of 68% for Medicaid patients and 75% for commercial health insurance patients. The industry average for six-month retention for in SUD treatment is between 25% and 30%,” Cooper Zelnick, Chief Revenue Officer, said at Behavioral Health Business’s VALUE conference.
“We’re held accountable, not for delivering services, but for retaining our members and producing lower cost of care,” Cooper Zelnick said, “We’re really proud of that.”
Caron Treatment Centers
Caron Treatment Centers is headquartered in Wernersville, Pennsylvania. As a not-for-profit substance use disorder (SUD) treatment provider Caron has over 60 years of experience.
Caron started a three-year pilot into a value-based payment model in 2017 with Independence Blue Cross (IBC). Of the 71 IBC beneficiaries treated by Caron, less than 6% relapsed within 90 days. Readmission rates for other providers in IBC’s network ranged from 12 to 26%.
When Brad Sorte became CEO in 2021, he told Behavioral Health Business that value-based care is the future of addiction treatment.
“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.”
Oceans Healthcare
Headquartered in Plano, Texas, Oceans Healthcare initially provided behavioral healthcare to older adults and seniors. Since opening its doors in 2004, it expanded to 33 locations, 23 hospitals, and 2,000 employees, treating 24,000 patients annually.
Ocean adopted a PHQ-9 as a measurement of outcomes in 2019 to improve the quality of care. Melynda Boothe, Executive Vice President of Process Improvement and Outcomes for Oceans, believes PHQ-9 assessments can be ideal for providers interested in value-based care because they help constantly assess the quality of services rendered.
Since 2019, Oceans has opened locations in Texas, Louisiana, and Oklahoma, starting this year with a new investment from Webster Equity Partners.
“We remain dedicated to quality inpatient care and are among the industry’s leaders in defining quality metrics,” Stuart Archer, CEO of Oceans Healthcare, said.
Spero Health
Spero Health is an integrated healthcare services organization specializing in drug and alcohol addiction treatment for individuals suffering from substance use disorder. Based in Nashville, Tennessee, Spero Health operates more than 70 freestanding outpatient clinics throughout Kentucky, Ohio, Indiana, Virginia, and Tennessee.
In 2021 Spero Health opened various locations across the country, including Ohio, Virginia, and Kentucky. However, at Behavioral Health Business’ VALUE conference, Steve Priest, CEO and President of Outpatient SUD provider Spero Health said that value-based arrangements couldn’t be operationalized because payers’ systems are built only for fee-for-service businesses.
SUDs are chronic by nature, Priest said, making them potentially prime conditions for payers and providers to engage in care and payment arrangements that focus on care outcomes.
