January 19, 2024
Article
Health Affairs Forefront

Value-Based Health Care Can Transform the Treatment of Patients with Substance Use Disorder

By: Robert S. Kaplan and Sarah E. Wakeman

Format:Electronic

Abstract

U.S. overdose deaths currently exceed 100,000 per year. New facilities, known as bridge clinics, are broadening access to high-quality care by offering outpatient substance use disorder (SUD) treatment with few access barriers. But many of the critical services offered by bridge clinics, such as recovery coaching and resource navigation are not consistently reimbursable under a fee-for-service payment model. Even for billable services, the existing billing codes fail to capture the intensity of bridge clinics’ full scope of work, such as post-emergency department (ED) ambulatory alcohol withdrawal management and medication for opioid use disorder (MOUD) initiation. These services, like ambulatory withdrawal management, often involve hours of direct nursing care and provider treatments whose costs far exceed current reimbursements under outpatient Current Procedural Terminology (CPT) codes. The payment failures can be addressed and solved, but not with ad hoc patches to the current fee-for-service system. Here, we describe how to dramatically improve care for patients with SUD by systematic adoption of four value-based care (VBC) principles. These principles, which are already being applied for other medical conditions, can be successfully introduced and scaled to accomplish large reductions in the US’s annual SUD-related death toll.