New Healthcare Payment Model Incentivizes Recovery

The Incentivize Recovery model is designed to promote improved integration of treatment and recovery resources.

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Recovery flourishes when the patient is well managed by a multidisciplinary care team.

This September, Facing Addiction with NCADD and other members of the Alliance for Recovery-Centered Addiction Health Services announced an alternative payment model for recovery. In a huge step forward for people in recovery and healthcare advocates, the new model centers recovery across a spectrum of care. The Incentivize Recovery model bundles payments, quality targets and shared-savings. It is designed to promote improved integration of treatment and recovery resources.

“As addiction to alcohol and other drugs now impacts 1 in 3 households in America, we must urgently work to turn the tide on this health crisis,” said Greg Williams, a person in long-term recovery and Facing Addiction with NCADD’s Executive Vice President. “In late 2016, the U.S. Surgeon General issued the seminal report on Alcohol, Drugs, and Health: Facing Addiction In America. In this report, an urgent call to action for mainstream health systems to begin integration of substance use health services was afforded an entire chapter, and the industry leaders in this Alliance have responded in unprecedented fashion to that call.”

This groundbreaking innovation acknowledges one important aspect of healthcare: recovery flourishes when the patient is well managed by a multidisciplinary care team. For many people with substance use disorder, the “spectrum” of care can include medical care, inpatient treatment for addiction, outpatient care, group or individual therapy, support groups, sober living homes, and medication. These services are not necessarily provided under one roof. Bundling those services is a vital step toward integrating recovery services and incentivizing healthcare providers to improve their treatment of substance use disorder patients.

“Designing a new payment and care delivery model is no small task and required a lot of work and collaboration,” said Joanna Hiatt Kim, vice president of payment policy at American Hospital Association (AHA). “We are thrilled that it is now public so that the most important work—the work to help our patients and our communities—can begin.”

The monumental work of coordinating the new plan was made possible with collaboration from the members of the Alliance, which include major commercial insurance plans, health care associations, health systems, and stakeholder groups. Diversity and integration are the north star of the new Addiction Recovery Medical Home (ARMH) model. As an Alternative Payment Model (APM), it’s engineered to provide patients with a long-term, comprehensive and integrated pathway to treatment and recovery. That means that people seeking care and support for substance use disorder will no longer have to design their own road map to wellness. Using supported, covered, and comprehensive approaches to care, they’ll be in better hands and have better health outcomes.

The new model is also innovative because it acknowledges that not everyone’s recovery is the same. Instead of a “one size fits all” approach, the model supports and celebrates all forms of recovery as desirable and achievable. Within the ARMH-APM framework, providers and payers are encouraged and incentivized to tailor the approach to the needs of each patient. That means complete abstinence from all substances may not be an initial recovery goal for many patients. Harm reduction, medication assisted recovery, and other approaches are supported as well. The care team is positioned to meet people where they are and move that patient along a journey toward improved wellness while reducing emergent risk factors.

The ARMH framework establishes a broad continuum of care ranging from emergent and stabilizing acute-care settings to community-based services and support that are essential to managing patient needs in a chronic disease model.

This new program is truly groundbreaking, and will have an immense, positive influence on the treatment of people with substance use disorder. Learn more at incentivizerecovery.org.

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