Consolidation and growth are happening in the office-based opioid treatment (OBOT) sector of the addiction treatment industry despite broader trends of market slowdown in the space.

OBOT models originated as a way to make medication-assisted treatment (MAT) with buprenorphine, methadone and naltrexone more accessible by bringing it into a less stigmatized medical environment. These models are still ripe with opportunity for scaling and innovating care, industry professionals told Behavioral Health Business at INVEST 2025 in October.

“I actually think we are in a growth stage and a consolidation stage,” Steve Priest, co-founder and CEO at Spero Health, said during INVEST. “But in reality, I’m pretty bullish about the next chapter and where we’re heading, because I do think there are huge opportunities in the space. We know there’s still a remarkably underserved patient population. We know the care we provide collectively makes a difference in people’s lives. And we know from a business standpoint that there is a unique opportunity for consolidation and for building at scale platforms that can provide even better care and then higher the ability to continue to grow across the United States.” 

Spero Health is a large outpatient addiction treatment provider headquartered in Brentwood, Tennessee, with operations across six states.

As OBOT clinic consolidation increases, the most successful ones are doing well for a few key reasons.

“The successful consolidators are doing so well because they’re prioritizing both operational and cultural implementation, as well as the financial synergies across the companies,” Krysta Cass, president of SaVida Health, an operator of dozens of OBOT clinics nationwide, said.

Yet despite OBOT’s recent growth, these programs still face hurdles with reimbursement, payer and workforce pressures. Specifically, when the industry is at an “inflection point” with rising medical costs and payroll spend.

“Over the last few years, you’ve seen this rise in the use of payroll spend, but you also see a decline in primary care visits, and so there is a shift in where the dollars are going,” Priest said. “The question is, can payers – thoughtful ones – understand that there’s an investment there that should pay off in a lower total cost? Are we going to ever benefit from that in terms of being attributable to the work we do? I highly doubt it, to be quite honest, but the reality of it is we still have to have a sustainable reimbursement model that allows us to continue to provide access points in care for a patient population that is very expensive to the payer. Sometimes it’s just the brutal facts that this patient population is really expensive to the payer.”

OBOT models generally offer a lower-cost service to this patient population that helps bend the cost curve, Priest explained, but still, there can be a disconnect between OBOT operators and payers, which is the impetus behind the recent launch of a new industry group called the National Alliance for Comprehensive Addiction Treatment Solutions (NACATS).

“It’s a 501(c)(4), designed around advocacy for a stable reimbursement model in high-quality care for our patient population,” Priest said. “We still have an access problem in the United States, even though frequently we talk about the overdose death rate may be going down and so that the problem is being solved. The reality is our patient population has simply evolved into a poly-substance use and is no longer just an opioid use disorder. We want to have a voice, and in doing so, we’re focused in Washington, DC, with CMS on sustainable reimbursement models in a bundle and we’re making a little bit of headway there.”

The key to driving those conversations and moving the needle is speaking the payer language, Cass stressed.

“I think our long-term value is created by closing the loop between medical care, counseling services and support services, and then being able to demonstrate the value of that integrated, coordinated care model through patient outcomes,” Cass said. “So being able to take a coordinated, integrated care model and demonstrate to payers that we are improving patient outcomes, reducing readmission to the emergency room, and being able to do that at a lower cost to both patients and providers for impact would be essential.”

Demonstrating the value of OBOT clinics to payers will become even more critical amid Medicaid cuts, which could greatly impact the eligibility of patients with substance use disorders (SUDs). So finding ways to partner with Medicaid payers and keeping patient eligibility in mind as a component of the treatment plan is one way to build access and outcomes, Doug Weiss, CEO of Porch Light Health, said during INVEST.

“We saw early on, as soon as Medicaid cuts were announced, our census started to flatten out,” Weiss said. “We asked, ‘What is happening here and in our patient engagement?’ What we found is our patients are afraid that they’re going to get a bill so they stop coming to treatment. The legislators don’t really understand this impact on demand that comes just from noise.”

With that in mind, Colorado-based Porch Light Health, a provider focused on community-based addiction treatment and recovery services, launched a service for MAT treatment on demand that connects a discharge planner with a patient as they leave hospital treatment to help them transition from the emergency department into SUD care quickly. It was an approach the Porch Light team worked on with a Medicaid payer.

“Our approach is to use different tools to help the patients, just as we did during the public health emergency and in the unwinding and make eligibility and financial relief financial pressure for our patients so that they will continue to come back for treatment,” Weiss said.

Prioritizing measures like that and building strong payer relationships simultaneously, though, can be challenging depending on the size and scale of the OBOT organization.

“I do think it’s hard if you’re a small organization in a single state,” Priest said. “It is really hard to build payer relations because you have to do it over time. And a lot of those folks, unfortunately, do change roles and change companies. We have some relationships that we just follow those individuals to different managed care organizations as they’ve moved, but it is a personal relationship. If you’re smaller scale, that is really complicated because you get stuck in the payer relations world and it is just a black hole. So scale does matter.” 

While scale does matter, what’s equally important for OBOT operators is to understand there are many parts of an organization’s team that engage with the payer and community partnerships and events can go a long way to building inroads, Cass explained.

“You can’t just drop a box of donuts off at the payer and expect them to call you back,” Cass said. “You have to nurture that relationship and share data in a very transparent way.”

SaVida operates 51 clinics across seven states, and sends one growth and outreach person in each state to community events, which typically also have state payers. That’s one strategy that has helped the organization build and maintain those relationships. 

“By doing that, we’ve built very strong inroads,” Cass said. “It took a long time to build, but it first starts with showing up. Show up, support your community and build inroads. Work with your company, the payer, and the community to demonstrate effectiveness and then continue to nurture that relationship.”