Addressing Key Barriers to Value-Based Payment for Substance Use Disorder (SUD) Treatment and Recovery: Current Gaps and Opportunities for Advancing Quality Measurement

Executive Summary 

Despite the potential for improved outcomes and cost savings resulting from the integration of substance use disorder (SUD) treatment and behavioral health services with physical healthcare services, uptake of alternative payment models (APMs) that can incentivize such integration have been relatively limited. In July 2021, the Duke-Margolis Center for Health Policy convened health systems, providers, state and federal policymakers, addiction experts, and other key thought leaders for a virtual roundtable to discuss key barriers and opportunities for advancing payment and delivery reforms that can support expanded access to high-quality SUD treatment and recovery services. Key takeaways from the discussion include:

• Behavioral health needs and drug-related mortality both increased during the pandemic, with widening gaps in access for individuals in need of SUD treatment services.
• Value-based payment (VBP) models have the potential to incentivize high-quality care, encourage longitudinal care coordination, and ensure appropriate linkages to support services as patients move through the continuum of care.
• Despite their potential to improve care, improve access, and reduce costs, APMs for SUD treatment are not widespread. Promising models include the Patient-Centered Opioid Addiction Treatment (P-COAT) APM, Addiction Recovery Medical Home APM (AMRH-APM), and CMMI’s Value in Treatment demonstration.
• Payers and providers face significant challenges in designing and implementing new APM models. Key needs for facilitating wider implementation of APMs include upfront funding for treatment infrastructure, technical assistance to support providers in building capacity, incentives for primary care providers to participate in collaborative care models, and improved linkages to community-based and wrap-around services.
• A significant challenge for wider implementation of VBP models for SUD is the relative paucity and lack of consensus around quality measures, with most measures focused on process and structure. Meeting participants highlighted the need for development of patient-reported outcome measures in SUD, and the need to disaggregate outcomes by race and ethnicity to ensure that the model reduces disparities in access and outcomes of treatment.

Based on this expert discussion, critical opportunities and next steps for advancing alternative payment approaches for SUD include identifying opportunities for integrating SUD in primary care; identifying strategies for improving consistent data collection, quality measurement, and analytical approaches; capturing early experiences in APM implementation and recommending opportunities 2 for improvement and broader use; and identifying actions states can take to support further adoption of SUD-focused APMs.