Despite the strong growth potential in the substance use disorder (SUD) treatment space, providers faced stiff headwinds in 2023, including rising patient acuity, access obstacles and shifting regulatory frameworks.
Some of these challenges will continue to present problems for SUD treatment providers in 2024, but the new year will also bring significant opportunities, industry insiders told Addiction Treatment Business. SUD treatment providers will diversify services and set industry-wide quality standards while harnessing innovation with AI and psychedelics.
Providers will also tackle reimbursement-related challenges as the industry continues to seek value-based care models.
ATB caught up with five industry insiders to reveal the key forces that will impact SUD treatment in 2024. Their responses, listed below, were edited for length and clarity.
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The top three challenges facing us for the next three to five years are staffing, staffing and staffing, in that order.
The largest generation ever to exist on the planet, the baby boomers, are beginning to leave the workforce. At the same time, we’ve got a significant gap: There simply aren’t as many Gen Xers. So there’s more work and fewer people to do it. The people who do have experience are beginning to leave that workforce. You have a challenge in the sheer number of individuals in the workforce as well as a leadership gap in the workforce.
We’re seeing a shift in the industry to include more standalone mental health. Organizations that have been traditionally addiction-only are creating outpatient programming that addresses standalone mental health and non-addictive issues. We’re also seeing long-term residential sites begin to add beds that are focused on individuals who are struggling with mental health issues, not just addiction issues. Caron is one of those companies.
Payers are talking about value-based care and also starting to define quality themselves. They are putting these definitions in their contracts and plans as incentives and creating metrics for us.
– John Driscoll, president and CEO of Caron Treatment Centers
I believe we will continue to see an increase in virtual care and value-based reimbursement to expand access, which will hold SUD providers accountable to outcomes (quality of care) rather than just quantity of care. I also foresee health equity being further established as a core expectation in SUD treatment, holding both providers and payers accountable for reporting equity data.
Outdated laws, licensing regulations and stigma will continue to challenge the ability to incorporate harm reduction, collaborative care and longitudinal care into SUD treatment, specifically in ways that drive the best possible outcomes.
By fall 2024, the DEA plans to promulgate a final set of telemedicine regulations for controlled substances, which will have a huge impact on the space. The Modernizing Opioid Treatment Access Act (MOTAA) is another one to keep an eye on. If passed, it will make methadone available by prescription for opioid-use disorder. Right now, it is only available at methadone clinics, so this would increase access to those who need it.
– Nzinga Harrison, co-founder and chief medical officer at Eleanor Health
A key challenge in 2024 will be the lack of behavioral health integration into the primary care setting. Working with primary care providers is a core part of our work, but we still have long access times for our clients who lack primary care physicians (PCPs) in some areas.
We’ve seen great steps in 2023 taken by SAMSHA to better define national model standards for peer certification, delivering a care model that lowers barriers to access and delivering quality outcomes in the SUD space in a way that the industry hadn’t coalesced on in prior years. While more ground needs to be made up, this is exciting progress toward aligning the industry on north stars that will guide our work for years to come. This work will continue in 2024 and is the foundation needed to unlock innovative financing mechanisms and payer partnerships in the space.
We, as an industry, have an opportunity to really come together to set the standards for how we measure the impact of our work. If someone completes a 30-day program but is back at home, in their bedroom all day, playing video games and not interacting with the outside world, is that a successful client outcome?
– Jenni Lohse, chief legal and administrative officer, Aware Recovery Care
Artificial Intelligence diagnostic systems will aid all of behavioral health in at least two ways.
First, AI diagnostics will enable earlier identification of behavioral health disorders. If primary care physicians, especially pediatricians, can identify behavioral health disorders earlier, they can work to head off the eventual use of substances, which are so often a form of self-medication for people struggling with mental health disorders.
Second, AI diagnostics will improve the prescription of psychiatric medications by reducing the trial and error often experienced when working with a psychiatrist to find the most effective medications for a particular person.
In 2024, psychedelics will be used to improve behavioral health care. Higher levels of care in SUD treatment exist to help clients achieve openness to ideas they’ve rejected many times, in short, how to live effectively and peacefully. The work done so far with psychedelic-assisted treatment indicates that this openness, in a word, neuroplasticity, can be accelerated with psychedelic medications. In combination with effective therapy, we will see a reduction in the need for higher levels of care. Clients who otherwise might need levels of care higher than structured outpatient (groups and individual sessions, but fewer hours than IOP) will achieve similar outcomes with psychedelic-assisted treatment.
– Peter Loeb, co-founder and CEO of Lionrock Recovery
The biggest issue facing SUD providers is the continued clash with payers, with the latter “winning” the battle at this point. This causes lower or flat reimbursement rates, which means that most centers can’t retain staff. This means there is constant turnover at SUD providers and quality of care suffers. You have talented therapists or clinicians across the country who leave facilities and open private practices as quickly as possible.
The Lighthouse has never lost a team member that we didn’t want to. Our staff loves working with us because we pay higher than market rates, we make sure they’re practicing self-care and we are super flexible. We are successful because we are not insurance reimbursement rate-driven. We set our prices to reflect the program we want to offer.
Value-based care is something that everyone says they want to move towards but putting it into place ubiquitously is years away, if at all.
