Healthcare group unveils payment model aimed at integrating addiction treatment into medical care

Medicine Money
A new payment model aims to promote more integrated addiction treatment. (Getty/utah778)

A group of healthcare organizations have teamed up to build a new payment model designed to promote long-term addiction recovery. 

Leavitt Partners, Remedy Partners and Facing Addiction with NCADD (the National Council on Alcoholism and Drug Dependence) unveiled the Addiction Recovery Medical Home (ARMH) model, which includes a continuum of care that is based on a chronic-disease model. 

Greg Williams, executive vice president of Facing Addiction, told FierceHealthcare it’s crucial that addiction is treated like a chronic disease for long-term recovery to be possible. 

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

“Unfortunately, our current treatment system was developed before we fully embraced this notion,” Williams said. “We built what’s essentially an infectious disease model for a chronic condition.” 

The ARMH model includes elements of fee-for-service payment and risk-based payment, and pushes for greater integration of behavioral health services into traditional healthcare services. Integrated care, Williams said, is key to promoting recovery long-term, as it ensures patients with substance abuse disorders are connected to the appropriate care, and that different providers are communicating more effectively with one another. 

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Williams said the payment model’s designers hope that it pushes providers to consider drug addiction alongside other chronic illnesses that require lifelong maintenance, such as diabetes. The current model, which is almost entirely episodic, fails to promote long-term care because providers benefit financially from relapse; it brings patients back in for more care, he said. 

“Today’s system incentivizes relapse—I get paid the more times I serve you,” Williams said. “The incentives are perverse.” 

Williams is himself in long-term recovery and said the fact that he’s been able to maintain sobriety under the current system is the exception, not the rule. 

“I’ve buried a lot of my friends and watched a lot of people not succeed,” he said. 

At least two pilots for the payment model are planned for 2019, and it has already garnered support and interest from some big names. ARMH is backed by the Alliance for Recovery-Centered Addiction Health Services, a group that includes the American Hospital Association, Anthem, AmeriHealth Caritas, Intermountain Healthcare and the Healthcare Financial Management Association. 

RELATED: Inova Health System joins shift in hospitals investing in inpatient behavioral health 

Having all of those stakeholders at the time was important to building the model, Williams said, as they offered varying perspectives on the best way to align incentives. These stakeholders, he said, will weigh in throughout the pilots as well to refine and adjust the model. 

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