Taking incremental steps is critical for providers looking to transition into value-based care models for substance use disorder (SUD) services.

Overall, SUD treatment is seeing a growing shift toward value-based payment models. This dynamic has the potential to improve patient outcomes, close care gaps and encourage integrated care coordination. However, providers looking to shift to a value-based care model often face a brick wall of challenges that is stacked with a lack of consensus on measuring quality and outcomes, workforce strains and care fragmentation.

Inching closer to adoption of these models shouldn’t be viewed as a destination but rather as a movement across a continuum, Brett Cohen, CEO of Recovery Centers of America, said during a panel at Behavioral Health Business’ VALUE Conference in March.

“Value-based care, to me, is not an endpoint. It’s a continuum,” Cohen said. “On one end of that continuum is traditional fee-for-service models. On the other end of the continuum is full-risk contracts or population risk. There are lots of steps in between: alternative paid models, case rates that are bundled, or some that are partially on the continuum.”

Recovery Centers of America provides addiction treatment across six states.

Metrics to Bring to the Negotiation Table

Determining which metrics and quality measures to prioritize for payer negotiations has been an ongoing challenge for behavioral health providers looking to switch payment models. According to a 2020 study, being “unsure of the specific expectations of contractors… has contributed to providers’ uncertainty of where to focus attention and resources.”

Because the industry lacks standardized metrics, it’s essential for providers and payers to come to the table to negotiate what will provide the most meaningful outcomes for patients, Kate Appleman, executive vice president for clinical programming at Caron Treatment Centers, said.

Some of those could range from shifting a focus from short-term abstinence rates to long-term outcomes, focusing on long-term engagement and reduced relapse rates, reducing costs related to ER visits and hospitalizations, and ultimately looking beyond immediate results, she said.

In particular, prioritizing long-term brain health as a core component of addiction recovery could also be key.

“We need to look at longer-term, sustained brain health and ways to measure that through brain mapping. That’s something that I think is incredibly important. That is where our field is going,” Appleman said. “I think that’s something that we’re going to continue to hear more and more about in our sector.”

Caron Treatment Centers provides inpatient and outpatient addiction and recovery care in seven states.

While payers and providers have begun to explore alternative payment models, few states have implemented value-based SUD care models. As of 2023, only eight states currently have ongoing value-based payment models developed for SUD care: 22 states had some evidence of doing so and 20 states had little to no evidence of this, according to the Substance Abuse and Mental Health Services Administration.

Sustainably moving toward a value-based payment model—even if not engaged in plans to shift fully into one— is still advantageous and worth focusing on, Melanie Adkins, vice president of payer contracting for Centerstone, added.

“As a provider, you need to really know what metrics you can meet. What are we prepared to do that measure our outcomes? Even if you’re not doing value-based care right now, do those things so that when you do come to the table, you’ll know whether you’re going to be able to negotiate for some of that based upon what the payer needs are,” Adkins said, “It’s important to know what metrics you are meeting, even if you’re not in a value-based care contract at the moment.”

Centerstone is a nonprofit health provider for addiction treatment and mental health services. It operates across six states.

Modernizations for Better Data

Improvements in technology are likely to propel more meaningful growth toward the adoption of value-based payment models across the industry. Longstanding issues with EHR systems, which have traditionally been used to collect and track patient data for physical health care, but not across behavioral care, have limited some of the measurements that could be tracked related to value and quality.

Modernizing technology infrastructure across the behavioral health workforce and business practices has been cited in studies as a major hindrance to reporting measurable data and expansion of services in some cases.

“Technology is going to be very critical for any provider who wants to move into value-based care, and you have to across the board engage your staff in the program,” Adkins said. “I think case managers are so key to success in value-based care programs for a provider, so you really need to make sure your case managers are engaged.”

Wearables, Adkins noted, will continue to be useful for providers to pay attention to, particularly in the way they collect real-time data for patient insights. 

Artificial intelligence may also be able to play a critical role in the future to support administrative and clinical functions and data collection as well, which is something the field should be paying attention to, Cohen added.

But one of the major ways technology could change the value-based payment models for the behavioral health field is in allowing for better risk stratification and predictive modeling, he said.

“It goes back to the point around data and really understanding how somebody presents and what the right interventions are to keep them well and in lower levels of care going forward,” Cohen said.