Insurers Can Benefit From Value-Based SUD Contracts

Health plans will see the best results in treating substance use disorder (SUD) by adopting a risk-sharing, value-based contracting model with providers, experts say. According to executives from a health plan and an addiction treatment provider, fee-for-service contracting can create incentives for providers that work against best practices in SUD treatment.

“Substance use disorder treatment, for decades in our country, [has] grown up outside of the traditional health care system,” said Stephanie Strong, CEO of SUD treatment provider Boulder Care, in a June 22 virtual panel discussion at the AHIP Institute and Expo. “And often, a lot of the policies and outcomes…[have] been the result of a lot of misinformation about this condition and its treatment. For example, the prevailing sentiment is, if someone has addictive disease, send them to rehab or a[n inpatient] facility — which may be for 30 or 90 days — and expect a cure when someone returns.”

That attitude is outdated, she says.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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