SAMHSA Experiences on Progress in Worth-Primarily based Fee for SUD Providers

As extra states start to experiment with value-based fee (VBP) for substance use dysfunction (SUD) remedy and restoration providers, the federal Substance Abuse and Psychological Well being Providers Administration (SAMHSA) is in search of to seize early implementation practices and experiences with the intention to spotlight alternatives for enchancment and broader adoption.

In a brand new report, SAMHSA notes that because of the magnitude of substance use issues (SUDs) in the US, there was a rising motion towards utilizing VBP for SUD remedy and restoration providers.

This report explores using VBP for SUD providers, summarizing proof for every state’s progress towards implementing VBP for SUD providers via a overview of publicly out there sources and documentation. The report additionally discusses the main challenges to adopting VBP for SUD providers and affords potential options to assist overcome them.

SAMHSA discovered that states are taking numerous approaches to implementing VBP for SUD remedy and restoration providers. Some states are proposing and passing legal guidelines to require a portion of funds for SUD providers to be tied to worth. Different states are utilizing Part 1115 Demonstration Waivers or different Medicaid waiver authority to set goal VBP targets throughout their Medicaid managed care contracts. 

There are different funding streams furnished via state and federal grants and applications, such because the Substance Use Dysfunction Prevention that Promotes Opioid Restoration and Remedy for Sufferers and Communities (SUPPORT) Act Part 1003 demonstration that allow states to make use of VBPs to broaden capability and improve the standard of SUD care. Some non-public suppliers, similar to Wayspring and Eleanor Well being, are partnering with managed care organizations to ship value-based SUD care regionally. 

As of March 2023, eight states have well-developed and ongoing VBP initiatives for SUD providers, whereas 20 states have low or no proof of VBP for SUD remedy and restoration providers and 22 states have medium proof.

SAMHSA notes that linking fee to outcomes is a problem for substance use issues, simply as it’s for different continual ailments that require long-term care. Different challenges recognized to the additional growth and implementation of VBP for SUD remedy and restoration providers embrace the fragmentation between bodily and behavioral well being care; workforce and coaching points; difficulties with measuring the standard of SUD remedy; limitations in information infrastructure and sharing capability; and underinvestment in SUD remedy and restoration providers.

The report says that potential options to those challenges embrace supporting care coordination, incentivizing supplier coaching in SUD remedy, creating consensus on significant patient-centered final result measures, and bettering information and record-keeping infrastructures.

“Sustainable, long-term monetary and stakeholder funding is required to help these options,” the report says. “With such help, VBP fashions have promising potential to enhance the standard and cost-effectiveness of SUD remedy and restoration providers nationwide.”