Can value-based care delivery change the equation around helping Americans living with substance abuse to recover, where fee-for-service and discounted fee-for-service healthcare could not? That’s precisely what a team of policy experts are contending, in a new op-ed in the Forefront section of Health Affairs.
In “Value-Based Care Can Transform The Treatment Of Patients With Substance Use Disorder,”published online on Jan. 19, Robert S. Kaplan, Ph.D., and Sarah E. Wakeman, M.D., look at the issues facing health system leaders who are working to help patients overcome their substance abuse issues. Kaplan is a senior fellow and Marvin Bower Professor of Leadership Development (Emeritus) at the Harvard Business School. He is the co-developer of activity-based costing methods and the Balanced Scorecard. Wakeman is medical director for the Mass General Hospital Substance Use Disorder Initiative, program director of the Mass General Addiction Medicine fellowship, and an assistant professor of medicine at Harvard Medical School.
Kaplan and Wakeman note that “US 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,” they note, “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.”