Expanding Value-Based Care to Addiction Treatment

By Matt Fisher, Esq
Twitter: @matt_r_fisher
Host of Healthcare de Jure – #HCdeJure

The shift to value-based care is impacting every aspect of healthcare. As has been well documented in many places, including this blog, value-based care is built upon the concept of driving enhancements to the quality of care while taking focus away from quantity or volume. While value-based care is often touted as intended to change the entire healthcare system, most of the efforts have focused on traditional medicine and perceived high-cost aspects of care. For example, bundled payments are often centered around surgical episodes of care and accountable care organizations ostensibly place primary care are the center.

While each of the value-based care models making headlines attempts to incorporate the full scope and continuity care, physical or “traditional” components of medicine receive the most attention. While care management, care coordination and some aspect of mental health certainly are part of the design, those aspects are not front and center.

With that in mind, the recently announced addiction recovery medical home – alternative payment model is intriguing. The “ARMH” is the result of a number of players in the healthcare industry coming together and recognizing the significant impact on overall healthcare driven by substance use addition and other issues. As explained by the alliance that established the ARMH, it is composed of five elements: (1) payment; (2) quality metrics; (3) integrated treatment and recovery network; (4) care recovery team; and (5) treatment and recovery plan.

While none of those elements is unique in and of themselves when it comes to alternative payment models in a value-based care world, the nature of addiction treatment is new. Addiction treatment can be quite difficult in practice because it may involve a patient population that frequently falls through the cracks in other systems, may not be on “lucrative” if any insurance plans, and otherwise does not usually receive the best attention. In attempting to reach this population, the ARMH will certainly face challenges and need to be fluid in its approach. However, challenges, whether anticipated or unexpected, are not a reason to forego trying to drive change.

The ARMH proposal comes at an appropriate time in light of the well-documented opioid epidemic driving so much of the news cycle as well as general substance use related issues. If providers are presented with a plan for incorporating treatment into other modalities, then the ripple effect could be significant. Since substance use disorders often lead to broader health issues, leaving aside its top or near to place in terms of causes of death, if substance use issues are removed as an issue for individuals, then other medical issues may resolve or decrease in frequency too. Additionally, utilization of resources could decrease, which means less drain on system resources and fewer access issues. As noted, the ripple effect can be potentially very big.

The fact that the ARMH has been proposed and now being implemented in some places is very significant. Substance use issues were often held back and kept in the shadows. That is the case in fewer circumstances now and stigmas are slowly being removed. If improving the overall health of America is the goal, substance use disorders cannot be ignored. Hopefully the ARMH is the first of many more steps in getting needed treatment to all individuals.

This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.