Almost 90% of opioid use disorder (OUD) treatment provider Groups Recover Together’s new payer contracts included a value-based care element. This starkly contrasts the vast majority of SUD providers, which still use the fee-for-service model.
Value-based care can align payers’ and providers’ interests, encourage providers to provide the most effective pathways to treatment and result in higher reimbursement rates. Groups established 43 new contracts with payers in 2023, of which 38 were value-based, according to Groups’ annual outcomes report.
Groups defines value-based as tying reimbursement to recovery, not volume of services. The new contracts represent 23.6 million newly-covered lives for the company.
“We’ve had a really great year from the perspective of delivering against our mission,” Cooper Zelnick, the company’s chief revenue officer, previously told Addiction Treatment Business. “We’ve continued signing value-based contracts and have continued delivering and improving our clinical outcomes. We feel like we’re in a stronger position now than we were at the beginning of the year.”
Woburn, Massachusetts-based OUD treatment provider Groups Recover Together offers its patients medication-assisted treatment (MAT) and virtual or in-person group therapy through “technology-assisted treatment.”
Despite the numerous hurdles facing substance use disorder (SUD) providers seeking a more value-based model, the industry remains focused on progressing away from fee-for-service models in 2024.
“By harnessing innovation and value-based arrangements, we are confident the industry can do much more for the millions of Americans with OUD,” Colleen Nicewicz, CEO of Groups, said in a statement.
Transitioning to value-based arrangements can prove tricky for providers who previously operated on fee-for-service models. Groups and tech-backed, value-based SUD provider Eleanor Health have told ATB that “growing up” value-based is easier.
“We’re lucky in that we were born and grew up value-based,” Zelnick said. “So we never had perverse incentives to deliver services that don’t drive value.”
Groups’ risk-based reimbursement model saved its health plan partners 37% on the total cost of care, according to the outcomes report.
In addition to expanding its value-based care arrangements, Groups saw growth in more traditional business metrics last year.
The company grew its patient base by 27% in 2023 and its staff by 23%. It also expanded into 40 new counties and one new state, Texas.
The company focuses state expansion on areas that are most impacted by the overdose crisis, according to the annual report.
“These are typically rural areas with high enrollment in Medicaid, signifying a greater need for quality care and services,” the report states.
People who live in rural areas die from opioid-related deaths at a rate nearly 13% higher than people who live in urban areas, according to the Centers for Disease Control and Prevention (CDC). Almost three-quarters of people who sought treatment at Groups live in rural areas.
The company has secured a sizable share of the SUD treatment market in the states where it has established operations. Groups’ treatment accounted for 13.2% of the total addiction treatment provided in these states in 2023.
The majority of Groups’ patients have public health insurance. In 2023, 68% of Groups’ patients were Medicaid beneficiaries and 6% were Medicare beneficiaries.
Across all demographics, Groups’ patients showed six-month retention rates three times the national benchmark. Its all-cause mortality rates were approximately two times better than the national benchmark.
Groups Recover Together Groups Recover TogetherHigh retention rates lead to significant cost savings for members and payers, the report said. Groups’ patients are $255 less expensive per member per month than people with OUD enrolled in other outpatient medication for opioid use disorder (MOUD) treatment, enrolled in inpatient treatment, or who are receiving no treatment.
“Our job is to retain members or patients and care to deliver engagement, attendance and abstinence, and if we do that total cost of care will come down,” Zelnick previously told ATB.
