A group of nine addiction treatment providers are coming together to advocate for reimbursement and standard clinical outcomes for outpatient care.
Steve Priest is the CEO of Spero Health, an outpatient addiction treatment provider based in Nashville, Tenn. The outpatient treatment space is relatively new, Mr. Priest told Becker’s, with most of the nine providers in the new alliance being formed in the past decade.
Over the past two years, Mr. Priest and other providers saw a need for outpatient providers to advocate for patients to states and insurers, he said. In March, Spero Health and peer providers launched the National Alliance for Comprehensive Addiction Treatment Solutions.
“Mission critical” for the alliance was to secure consistent reimbursement for outpatient addiction treatment services, Mr. Priest said.
Some state Medicaid programs and commercial insurers have well-thought out models for reimbursing substance use disorder care, he said. In Spero Health’s case, the company is operating in 28 states with hundreds of insurers.
“Bluntly, everybody does it differently. Some are well designed and thoughtful, and some are an afterthought,” Mr. Priest said. “What we’re trying to say is, there’s a real need for agreement on what good care looks like, what long-term, sustainable, fair reimbursement looks like.”
The alliance is in its “forming and storming face,” Mr. Priest said, and a top priority is advocating for enhanced Medicare’s payment models for substance use disorder care.
“If you can get a Medicare reimbursement model that is not a fee-for-service model, but a value-based, bundled rate, designed around this being a chronic disease state — if we can get this done at the federal level, what you see happen, historically, is states, Medicaid programs will adapt that model. Then, lastly, the commercial folks will generally adapt that model,” he said.
The Alliance is also working to develop consistent quality metrics for outpatient substance use disorder treatment. Because the space is relatively new, there are yet to be agreed upon clinical metrics for successful care, Mr. Priest said.
“We’re providing care for tens of thousands of patients every month. Why don’t we begin to look at this patient population and say, ‘this is what we think great care looks like,'” he said.
Beyond advocating for reimbursement, outpatient providers have an opportunity to be a voice to policymakers about the needs of patients with substance use disorder, Mr. Priest said. Outpatient providers are touching patients most often, he said, with the average patient at Spero Health visiting three-and-a-half times a month.
“We think we can be a voice for the states, the Medicaid programs. We can be a voice to answer questions about this patient population, how we’re seeing it evolve and change, so they can create a policy to adapt to those changes,” Mr. Spero said.
