The Substance Abuse and Mental Health Services Administration (SAMHSA) finds that meaningful development of value-based care policies for addiction treatment among the states is a rarity.
Only eight states have “well-developed and ongoing” initiatives for addiction treatment, according to a new report released Monday. Twenty-four states had quality performance initiatives in their Medicaid programs, while 20 had low or no evidence of value-based care policies.
States were also assessed on the intensity of their various value-based care efforts. The SAMHSA report details a scale with four categories, one being the least intense and four being the most intense.
“It is important to note that our review did not find evidence of any states currently using VBP strategies for SUD treatment and recovery services that fully align with either Category 3 or Category 4,” the report states.
However, nine states were assessed as having policies that included parts of multiple categories.
The report was short on specific care-focused outcomes, citing “a lack of data on the impact of [value-based care] on clinical outcomes.” It did say that value-based care models allow providers flexibility and enable “person-centered” care.
“Sustainable, long-term financial and stakeholder investment is needed to support these solutions,” the report states. “With such support, [value-based care] models have promising potential to improve the quality and cost-effectiveness of SUD treatment and recovery services nationwide.”
However, systemic challenges prevent the broader adoption of value-based care and policies that call for it. The report highlights these challenges of care fragmentation, workforce issues, quality and outcome measurement, technology and underinvestment.
At the most basic level, public and private payers have long bifurcated the administration of behavioral health benefits from physical health benefits. A rising acknowledgment of the interplay of behavioral health and physical health in the health insurance industry saw a handful of similar deals where large health insurance companies acquired behavioral health-specific insurers such as Beacon Health Options and Magellan Health.
“As many of us know, behavioral and physical health care typically take place in different care silos,” Elian Rosenfeld, senior study director for Westat, a contributor to the report, said during a related webinar on Monday. “There are different structures. … And this matters for value-based care because linking care, following up on care, and then having those outcome measures and quality measures linked up to the care provided is an essential component.”
The report highlights that the bulk of progress in value-based care development has come from managing spending on physical health.
Several of the challenges and solutions presented in the report include the use — or lack thereof — of technology such as electronic health records or data tracking platforms.
The report suggests that states and other government organizations allocate funding to cover startup costs for new value-based care arrangements. These funds could cover the purchase of products, training for new staff, and reimbursement for simply switching from a fee-for-service model to a value-based care model.
The impetus of value-based care arrangements can come from both the top-down and bottom-up.
With the lack of wider state movement, there is considerable space highlighted by the report to have state regulators and legislators mandate value-based care directives for managed care organizations (MCOs), the private organizations that manage Medicaid benefits on behalf of state governments. An equally good place to start could be among organizations at the community level.
“The first step is to identify some of the key pain points that resonate with both the payer and the provider,” Eric Bailly, senior director at Third Horizon Strategies, said on the webinar. “If there is a specific community, through the proxy of a payer, that is seeking to drive down overdose rates, for instance, then there should be a framework around incentivizing connection to medications of opioid use disorder … through localized or partnership service, e.g., telehealth.”
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