Medication-assisted treatment (MAT) has increasingly become the gold standard for treating opioid use disorder (OUD). However, the industry has a long way to go in developing more therapies to better support patients with OUD.
OUD treatment provider Groups Recover Together leverages MAT and group therapy to promote members’ recovery through in-person or virtual care models.
MAT is only effective when combined with psychosocial modalities but the treatment needs to be more widely-adopted, according to Cooper Zelnick, the company’s chief revenue officer. Zelnick, who is in recovery himself, sees improving access to Groups’ multi-pronged approach to OUD as core to the company’s mission.
Zelnick sat down with BHB to discuss taking risk to achieve value-based payment models, how technology can improve and limit access to care and the future of medication-assisted treatment.
Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: About 97% of Groups’ revenue comes from value-based payment agreements. How did Groups set up these contracts with payers?
Zelnick: The first reason we are able to do this against the backdrop of an industry that remains predominantly fee-for-service is that we are very focused on delivering great outcomes, being transparent about those outcomes with our plan partners and being willing to take risk on those outcomes.
Whenever folks ask me about transitioning their contracts to value or pursuing a value-based care strategy, question one is, ‘Do you have a clinical model that delivers powerful clinical outcomes?’ Question two is, ‘How willing are you to take economic risk on those outcomes?’
The biggest challenge is moving from philosophical alignment with health plans to a structure that meets all of the needs of those plans within a contract.
Our job is to retain members in care to deliver engagement, attendance and abstinence. If we do that, the total cost of care will come down based on internal data, our studies and a whole host of published research that has nothing to do with us.
Saying to a plan, ‘Given that, we would like to be incentivized to deliver that set of outcomes,’ is non-controversial. The part that’s really tricky is meeting the second and third-order needs of our plan partners in a way that allows that incentive alignment to carry through to a contract.
The primary challenge is that it’s really hard to shift from a fee-for-service to a value-based methodology. We’re lucky that we were born and grew up value-based. We never had perverse incentives to deliver services that don’t drive value. For providers who have been forced to exist off the fee schedule, I think that transitioning to value is tricky for many reasons.
Groups leverages medication-assisted treatment (MAT), namely Suboxone, to treat OUD. Do you think MAT is the future of SUD treatment and that abstinence-only approaches will become less common?
MAT is a critical part of treating substance use disorders and will remain so. I don’t think it’s the silver bullet.
From a clinical outcomes and data perspective, there is strong evidence that medication-assisted treatment is the best modality we have today for the treatment of opioid use disorder. That’s not as clear when it comes to alcohol use disorder. It’s not at all clear when it comes to stimulant use disorder.
But when it comes to opioid use disorder, MAT, specifically buprenorphine, Naloxone or Suboxone, is the primary tool we have in our tool belt. It’s not the only one. I would argue it’s only efficacious in combination with psychosocial modalities, but it’s a really important one and probably will be for quite some time.
With that said, medication alone doesn’t solve this problem. Our outcomes are some of the best in the industry. We retain 68% of our members at six months, meaning that 32% have fallen through the cracks. I would argue that’s not good enough. I hope that more modalities will be developed for the more effective treatment of addiction in the future.
So, if you’re asking if I think MAT is the perfect solution? God no. Do I think it’s a really great solution that needs to be more widely adopted? I certainly do.
Groups has capitalized on technology to improve patients’ access to care. What challenges presented themselves when implementing those new tech systems?
Technology in and of itself solves a lot of problems, reduces a lot of barriers and creates others.
With technology, there are a number of barriers. Are the systems working? How do we integrate our tech stack with legacy EMRs? Even moving beyond the internal barriers we face, some folks who didn’t have access to transportation now don’t have access to bandwidth. Some folks who didn’t have access to a car and don’t have access to a smartphone. We spent a lot of our time trying to mitigate those barriers. Our data shows that embracing technology has net reduced barriers to accessing care. But there are people who today can’t complete our intake funnel, because they’re not sufficiently comfortable using a smartphone app. I think we have a responsibility to deal with that.
Looking ahead, what innovations could pique Groups’ interest?
Core to our mission is serving everyone who has substance use disorder. A big part of fulfilling that mission for us is working with departments of corrections and serving folks who are coming out of incarceration.
Those are folks who don’t have smartphones in many cases and, in some instances, aren’t comfortable using those smartphones. We’re working to arm those folks with smartphones and tablets. We’ve received grants, so we can give those out for free. We’re working to help people get access to free or extremely cheap high-speed internet. But that is not the solution, or the only solution, for everyone.
How do we use our rural footprint and local care teams to help folks who can’t engage with technology to still get treatment? There are a lot of answers to this question. My view is that technology has a role to play, but it’s not the only answer.
