Outcomes data has been touted as both the key to value-based care and the best leverage SUD providers have in payer negotiations.
A handful of providers are seeing that in reality: Some payers are becoming amenable in negotiations when outcomes data is on the table, industry insiders said at the Behavioral Health Business INVEST conference.
However, there is still skepticism about the value of stretching an organization to implement outcome data initiatives. Acquiring data to bring to the table for negotiations in the first place is difficult. Even once acquired, these statistics may not significantly move the needle.
“We’ve had some success with one-off payers digging in where there are obvious wins in retention,” Masroor Ahmed, CEO of Symetria Recovery, said at INVEST. “It feels like everything’s moving at a snail’s pace and that it’s not moving fast enough.
“When I zoom out, I think payers are moving. It’s just they’ve got their tech stack and legacy, antiquated org design that makes it hard.”
Naperville, Illinois-based Symetria Recovery operates 13 SUD treatment facilities in Illinois and Texas, according to its website. It offers medication-assisted treatment, mental health care and intensive outpatient programs (IOPs).
Connecting patients with SUDs with timely treatment can lead to significant cost savings. Providers should “feel emboldened that the data is on our side,” Ahmed said.
Roy Serpa, chairman of the board and co-owner of T&R Recovery Group, went further when describing payers’ relationships with outcomes data.
“They give lip service to it, in my opinion and for the most part,” Serpa said. “Sometimes they have their own outcomes of your data. A lot of times we’ve received data on outcomes of what they have of us, and it’s wrong. … So you need to challenge [that] with your own data and put it up side by side with them and show them.”
T&R Recovery Group treats SUDs, mental health issues and trauma. The provider operates facilities in Arizona, Florida and Texas. In May, the Tucson, Arizona-based provider acquired Origins Behavioral Healthcare, adding four locations to its footprint.
The possibility for payers to have incorrect outcomes data necessitates a strong payer strategy, Serpa said. He identified the need for this plan as the most pressing challenge for SUD treatment providers broadly.
In order to develop a payer strategy, providers must do extensive research, including learning competitors’ rates, completing SWOT analyses and consulting with an expert, likely someone who previously operated in the payer sphere.
Still, some providers may struggle to present compelling data. For smaller providers, it’s a “David and Goliath” situation to acquire available data, according to Ahmed.
The future of SUD outcomes data
While potential struggles exist for providers seeking to construct payer strategies, building outcomes measures is key to value-based care in the future. Providers are divided on how actionable value-based care structures are.
This future may be further away than industry discussion might lead one to believe, according to Serpa.
“I think it’s BS — I’d rather focus on today, plan for the future,” Serpa said about discussions regarding value-based care. “We all need to pivot and adjust to what the payers need to feel validated for the reimbursement they’re providing.”
The concept of value-based SUD models is strong, Josh Scott, CEO of Guardian Recovery said at INVEST, but challenges do exist when operationalizing alternative payment arrangements with payers.
Delray Beach, Florida-based Guardian operates 17 physical SUD and mental health treatment clinics and a virtual care option. The provider previously told BHB that it plans to double in size over the next two to three years.
Outcomes data does drive real, meaningful care, Scott said, and payers’ “hearts are in it.” However, payers lack the necessary sophistication, he said.
“Value-based models haven’t caught up with capabilities and back office infrastructure and administrative capacity from payers,” Scott said. “There’s a real opportunity for all of us to work together in lockstep and [for] payer partnerships to help drive the conversation forward for value-based care and to bring more meaningful outcome data to the table. I think the onus lies on us as providers.”
Developing stronger relationships with payers is one of Guardian’s top two priorities for the next few years, according to Scott. Similarly, T&R Recovery sees connecting with payers about their needs as a critical issue for providers.
At the end of the day, investing in quality care practices, even some that may not be reimbursable, is key to growth, according to Ahmed.
“The elephant in the room is: half of the folks who enter treatment, between three, four, five, six months, are no longer in treatment, ” Ahmed said. “So what are you doing about those folks? Our investment of time has really been about understanding why folks leave. … And, more importantly, what we can do?”
