September 17, 2019 –Today, in recognition of National Recovery Month, the Alliance for Addiction Payment Reform (Alliance) announced demonstration pilots for the Addiction Recovery Medical Home - Alternative Payment Model (ARMH-APM) and a new consensus episode of care definition aimed to improve long-term outcomes for addiction treatment and recovery. The work represents collaborative efforts between the Alliance and payer and provider partners in Connecticut, Kentucky, North Carolina, Tennessee, Texas, and Washington D.C. to advance value-based payment demonstration efforts that will save lives, focus on improving outcomes, and reduce health costs.
“Transforming the delivery of addiction treatment and recovery services in America is going to take visionary leadership from all sectors of health care,” said Greg Williams, manager of the Alliance for Addiction Payment Reform from Third Horizon Strategies and a person in long-term recovery from addiction. “No longer can we afford to try the same thing over and over and expect different results. Today, this group of health care organizations is taking revolutionary steps forward to solve for the perverse incentives that have led to persistent network adequacy failures and fragmented services for the over 20 million individuals suffering from substance use disorders and their families.”
Addiction treatment has historically largely been delivered only in acute care settings which are inherently more expensive and have minimal ability to achieve quality outcomes when utilized in isolation, as opposed to a chronic care model designed to create long-term sustainable recovery outcomes. The ARMH-APM framework establishes a broad continuum of care ranging from emergent and stabilizing acute-care settings linking with community-based services and recovery supports that are essential to supporting individuals’ needs in a chronic disease management approach.
“Overdoses have risen to become the leading cause of accidental death for those under 50, while alcohol-related deaths still out-pace those from opioids with far less public attention paid to that substance,” said David Smith, a lead architect of the ARMH-APM and founder of Third Horizon Strategies. “The Addiction Recovery Medical Home Alternative Payment Model promotes improved integration of comprehensive substance use treatment and recovery support services with corresponding financial incentives that benefit all stakeholders when the individual is engaged with an integrated care team.”
The Alliance’s current work is built on the foundational effort convened by Leavitt Partners, Facing Addiction with NCADD, and Third Horizon Strategies to develop an APM that could be scaled and advanced through interested parties. In September 2018, the Alliance published the ARMH-APM white paper. Today, the Alliance is releasing an important update to this foundational document that includes a new comprehensive bundle definition prepared in collaboration with Remedy for health care stakeholders who desire to implement the model.
“An episode of care-based model for addiction recovery creates a wholesale, top-to-bottom reordering of the way health care is delivered, measured and paid for,” said François de Brantes, Senior Vice President of commercial business lines for Remedy.
In addition to ARMH-APM specific pilot projects, the Alliance is proud to be collaborating with organizations that have adopted general principles of the ARMH and are operationalizing related value-based payment models for addiction treatment and recovery services.
“We launched Eleanor Health as the first addiction treatment organization developed for value-based care and have been guided by the important work of Alliance for Addiction Payment Reform,” said Corbin Petro CEO and Co-Founder of Eleanor Health. “We are committed to supporting individuals with substance use disorder from a chronic disease management framework and being reimbursed by payer partners accordingly by producing long-term measurable positive health outcomes.”
The Alliance intends to continue supporting the ARMH-APM in additional demonstration markets in 2019 and beyond. A research methodology is being developed to study the effects of value-based models when compared to fee-for-service models of care and to study correlations between specific model tenets and the corresponding outputs.
“As health care increasingly moves towards value-based reimbursement strategies, the Addiction Recovery Medical Home Alternative Payment Model provides a promising learning opportunity for a condition that historically has been left out of most payment innovation efforts,” said Dr. Mark McClellan founding Director of the Duke-Margolis Center for Health Policy at Duke University and Former Administrator of the Centers for Medicare & Medicaid Services. “What we can learn from these important pilots will help to inform the future of care delivery for addiction and co-occurring mental health disorders.”
For more information about this work please visit: https://www.incentivizerecovery.org.