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Alliance Announces Demonstration Pilots for Value-Based Payment Model

September 27, 2019

The Alliance for Addiction Payment Reform, a collaborative comprised of commercial insurers, healthcare associations, health systems and other stakeholders in the field of addiction treatment, has announced demonstration pilots for its alternative payment model, as well as a new consensus episode of care definition aimed at improving long-term treatment outcomes.

The Addiction Recovery Medical Home – Alternative Payment Model (ARMH-APM) pilots are the result of work between the Alliance and payers and providers in Connecticut, Kentucky, North Carolina, Tennessee, Texas and Washington, D.C. The demonstration pilots will vary based on market, says Alliance manager Greg Williams, who also serves as managing director of the firm Third Horizon Strategies.

“The unique element in this work is we aren’t doing this on behalf of the federal government or a dedicated funding source,” Williams says. “We’re finding highly aligned stakeholders with money in the system already and making a proposal to reorient how they are spending their money into this model.”

Williams tells Behavioral Healthcare Executive that the goal of the project is to “reverse the perverse incentives” of the fee-for-service addiction treatment model.

“For chronic disease management, (fee-for-service) doesn’t necessarily bode well for the best outcomes or align incentives across payers, providers and patients,” Williams says. “And patients, unfortunately, don’t get the access nor the care that they need.

“We are working with a couple payers and providers in different markets to implement this learning model. The goal is to build a comprehensive integrated treatment and recovery network that can coordinate care for people across a continuum with a wide variety of services and meet them at different points of entry, and align the economics across a longer period of time for a health system or network to deliver care for someone to keep them engaged.”

The Alliance’s model, Williams says, aligns incentives among stakeholders, orients the clinical delivery system to improve outcomes, and encourages providers to be more flexible. The model’s framework establishes a continuum of care that ranges from emergent and stabilizing acute care settings to community-based services to recovery supports, girded by a chronic disease management approach.

“(Addiction) is a spectrum disorder and people need different things at different points of the continuum,” Williams says. “(The Alliance model) allows providers to work in a more flexible way with individuals based on their specific needs.”

The framework for the Alliance’s alternative payment model was first outlined in a whitepaper published in 2018. Earlier this month, the Alliance published an update that is now available for download.

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