The Addiction Recovery Medical Home As An Alternative Payment Model

Kind of in the weeds, but interesting nonetheless…

While the current opioid epidemic has captured the attention of the country and its policy makers by becoming the leading cause of death in the United States for those younger than age 50, addiction to a broader range of substances has pervaded US culture for decades. Current health system resources remain inadequate to thwart the rising tide of addiction, as demonstrated by recently released federal data that estimate a persistent 88 percent substance use disorder (SUD) treatment gap for those in need. This gap reflects inadequate infrastructure—resources, clinical settings, and workforce—for supporting the more than 18 million Americans suffering from addiction without appropriate treatment for their potentially fatal health problem.

The chronic nature of addiction means that it requires the same approach any chronic disease model would demand in integrating provider resources, coordinating information, providing continuity in patient engagement, and ideally, including a payment model that incentivizes these features. A longer-term focus on and support for patients managing a litany of care transitions in their recovery journey has the potential to markedly improve recovery rates and serve more people in need. For example, a patient in sustained recoveryfor one year can see remission of the worst symptoms of the SUD, while those in sustained recovery for five years can reduce risk factors close to population health baselines. Yet, despite research telling us what is possible, we are a long way from providing payment and treatment models that can produce these types of outcomes for addiction. US health care payment reform has only begun to scratch the surface on driving risk-based provider integration in core health care domains.

In August 2017, Leavitt Partners and Facing Addiction with the National Council on Alcoholism and Drug Dependence convened a group of 40 health care thought leaders including senior representatives of various health care organizations ranging from health insurers, hospital systems, subject matter experts, behavioral health executives, employers, and others. The purpose of this meeting was to discuss the future of addiction treatment and recovery in the US and determine if the market conditions were right to explore the creation of alternative payment and delivery pathways designed to promote long-term recovery. In the months that followed, this group organized the Alliance for Recovery-Centered Addiction Health Services (Alliance) to develop and promote an innovative approach to payment, patient engagement, and delivery of addiction treatment and recovery services.

The addiction recovery medical home alternative payment model (ARMH-APM), the concept ultimately developed by the Alliance, represents a cross-sector attempt to establish a structure that promotes health system integration resulting in improved outcomes for all stakeholders, most importantly the patient.

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