The merit of an integrated addiction treatment model is grounded in three key elements: the value to the patient, the value to the provider and the value to the payer.
“If we could find value-added items that meet those three aims, then that’s a no-brainer,” Nick Stavros, CEO of the Scottsdale, Arizona-based outpatient medication-assisted treatment (MAT) provider Community Medical Services, said during a panel at Behavioral Health Business’ INVEST 2024.
However, it can be tough for addiction treatment providers to find new services that meet these three aims. Growing service lines also requires that owners, investors and operators have very clear understandings about the company’s scope and mission, Stavros added.
Community Medical Services serves 21,000 patients via approximately 75 clinics in 13 states. Their integrated addiction treatment model addresses conditions that would otherwise go untreated. This includes testing and treatment for blood-borne and sexually transmitted diseases and psychosocial therapies.
The company also tries to account for the regional nature of health care. Community Medical Services has also added psychiatric services, acupuncture, yoga and cross-fit (at one clinic) to its opioid treatment programs (OTPs) and office-based opioid treatment (OBOT) programs.
Integrating physical and mental health care into SUD care can lead to holistic health improvements and ease patients’ paths to recovery. Some specific tether to physical health that Stavros highlighted include wound care.
“There’s plenty of research that shows if you treat the behavioral and mental health needs of a patient, you tend to get much better outcomes on the physical health side, whereas in the past, it’s been siloed,” Stavros said.
Providers’ considerations regarding integrated addiction treatment models quickly move from its merit to strategic considerations — not the least of which is determining whether to offer these services in-house or to partner with another organization. Scale is also a key consideration, Lee Dilworth, founder and CEO of Nashville, Tennessee-based ReVIDA Recovery Centers, said during the panel.
“We have to be opportunistic, and so we have to look at the individual markets because we’re smaller,” Dilworth said.
For ReVIDA Recovery Centers, being opportunistic means partnering with outside organizations when offering in-house services is simply not realistic. These partnerships include a hospital’s mobile mammography or a state harm reduction mobile unit, which set up shop outside Revida’s clinics, for example.
“You can’t [operationalize] this without collaboration,” Dilworth said.
ReVIDA Recovery Centers operates 12 OBOTs with plans to open two more and treats about 4,000 patients in Tennessee and Virginia.
Dilworth added that any integrated addiction treatment model requires providers to collaborate internally and with other organizations. Change management is vital to ensuring that strategic changes do not damage company culture.
“You’ll have folks that say, ‘Hey, that’s not what we do. We treat SUD patients and these patients that are coming in with higher mental health acuity — we don’t want to deal with these challenging patients,’” Chad Koller, division vice president of substance use disorder at Universal Health Services (NYSE: UHS), said at INVEST. “There is a little bit of education, there’s a little bit of training, there’s a little bit of shifting the culture.
“These are the patients [who] we’re seeing in the market, and we need to be prepared to provide services,” he continued.
UHS, a large acute care and behavioral health hospital company, operates 15 addiction treatment locations, Koller said.
Within his division, UHS has focused on quickly diversifying its in-house services using existing infrastructure. In a few cases, this has been as simple as hiring therapists to offer mental health services reimbursable through existing payer contracts. Such endeavors can be launched at addiction treatment-only locations in as little as a few months.
UHS’ focus on increasing outpatient services within the SUD division is also an attempt to align with payer behavior. Payers often compress inpatient lengths of stay and encourage outpatient services. An outgrowth of that has been margin accretion. In some of UHS’ standalone intensive outpatient programs, margins can reach 60% compared to 20% in inpatient settings.
Finding fiscal success with these models requires payers’ buy-in, each panelist said. At inception, integrated models may require providers to negotiate additional payer contracts for new services or to expand existing agreements. In more advanced payer-provider relationships, it may require building reimbursement arrangements that begin to resemble value-based care deals.
“It can be very challenging to bring your payers along and see the value of it … and to actually pay for a little bit of that,” Dilworth said. “They’re very much enjoying the benefit of it.”
One way to get payers on board is to collect outcomes and process data, including and beyond what is typically required through in-network contracts. This can include treatment progress data such as longitudinal PHQ-9 and GAD-7, Brief Substance Craving Scale and post-treatment outcomes.
That requires providers to “know [their] data really well,” Stavros said.
“Know where you should focus your efforts,” Stavros added. “If you’re trying to do this without data, and it’s just anecdotal, it’s probably not going to be as successful.”
