What is value-based care?
In addiction treatment and healthcare at large, value-based care is defined as care that focuses on quality over quantity. It puts the client and their overall needs at the center of care, giving providers both greater accountability and greater flexibility to deliver the right treatment and interventions at the right time. This form of care differs from the traditional fee-for-service model, in which providers are paid on the volume of services delivered.
Why value-based care?
The fee-for-service model can be particularly harmful in addiction treatment settings, where treatment at the wrong level of care or for an insufficient period of time can lead to a return to substance use, overdose or even death. Additionally, movement toward a value-based care model can result in significant cost savings, ensuring that individuals are receiving ongoing recovery support rather than driving up costs through sporadic readmissions or emergency room visits.
Research has shown that value-based care models can reduce costs and improve quality of care. They can also allow providers the freedom to innovate their treatment delivery and promote multidisciplinary collaboration to treat the whole person.
Benefits of value-based care
Value-based care benefits clients, providers, payers and society as a whole.
- Clients: With value-based care, clients are more likely to get better faster, rather than churning through a system with a fixed length of stay that may not fully address their treatment needs. Value-based care allows for a person-centered, integrated treatment approach that makes it easier for clients to effectively address their mental, physical and behavioral health needs. Effective value-based care also addresses social determinants of health like housing, economic stability, relationships and other factors that can impact recovery.
- Providers: Providers experience greater satisfaction and less burnout when alliance-building, rather than paperwork, is at the heart of their day-to-day work. For many, value-based care enables clinicians to return to the reasons they entered the treatment field in the first place. Client engagement measures increase when the focus shifts toward a value-based approach, indicating a higher likelihood of treatment retention and thus a reduction in costs for readmission and early dropout. Incentive-based payments for value-based care can help treatment organizations continually improve and expand their services.
- Payers: Value-based payment models allow payers to increase efficiency by bundling payments that cover a full continuum of care for patients, rather than processing many claims over a short period of time.
- Society: Society benefits immensely when individuals with addiction receive high-quality, individualized treatment. The value-based approach uses clinical expertise and quality care to drive costs down, helping eliminate spend on emergency interventions. More importantly, healing can take place in communities and family systems with each person that successfully enters recovery. Violence, overdose deaths, mental health crises and harmful generational cycles can be drastically reduced. Lives can be saved — and there is no price tag for the value this adds to society.
Getting started with value-based care
Implementation of value-based care models can take time, but a few steps can prepare your treatment organization for value-based care contracts with payers:
- Implement The ASAM Criteria – The ASAM Criteria sets the standard for addiction treatment placement at the right level of care. Ensure your staff and leadership are trained in the proper use of the Criteria, and for adult residential programs, consider working toward ASAM Level of Care certification by CARF International. This certification helps demonstrate to payers that a treatment program has the ability to deliver services consistent with the levels of care described in The ASAM Criteria.
- Monitor progress – Make the treatment plan a living, breathing document that is revisited regularly, and make adjustments as needed to ensure clients have what they need to achieve their individualized treatment goals. Find ways to increase treatment engagement (including after discharge) and monitor how retention improves as a result.
- Leverage technology – In an understaffed field, value-driven technologies can help expand clinical expertise in your organization and ensure individualized interventions are being delivered at the right time to your clients. Digital platforms like Atlas don’t replace the therapeutic alliance, but rather enhance it, creating opportunities for additional insight on each client, between-session engagement and evidence-based tools for reflection, skill development and self-motivation.
As awareness of the benefits of value-based care increases, so will the demand in the addiction treatment field. Leadership can prepare by ensuring effective implementation of The ASAM Criteria, monitoring progress and collecting outcomes data and leveraging technology to support staff and engage clients.