On February 22, 2023, the Alliance for Addiction Payment Reform (Alliance) kicked off its first quarterly learning collaborative meeting of the year. Nearly 100 people joined the discussion to learn about payment innovation across the county and critical policy implications that impact substance use disorder (SUD) alternative payment models. The Zoom meeting recording can be found on the following link:
The meeting featured a spotlight presentation by Andy Kelly, Vice President of Provider Enablement at Optum Behavioral Health. The provider enablement team’s role is to evolve how Optum thinks about value-based contracting by furnishing the tools that allow providers to give high-quality whole-person care to achieve outcomes. Andy addressed the importance of aligning payer and provider goals, overcoming common obstacles of value-based models, and the rise of collaboration between stakeholders.
Following the presentation, the Alliance discussed the following key policy and industries activities:
- The Centers for Medicare & Medicaid Services (CMS) approved California’s 1115 Waiver that allows the 90-Day Re-Entry Period to be covered by Medicaid. There are 14 other states with pending waivers requesting to waive the inmate exclusion policy, the requests do not precisely mirror the program elements that California set forth but pave the way for individuals incarcerated with a SUD and opioid use disorder (OUD) to receive life-saving treatment before release. The Alliance will continue monitoring this activity and its intersections with value-based activity.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) released a set of strategies for state funding of Recovery Support Services Survey and Recommendations. These strategies and support are vital as recovery services are a key component in the ARMH and any SUD-centric APM.
David Smith, Founder and CEO of Third Horizon Strategies and Co-Founder of the Alliance, discussed the regulations and opportunities around Transparency in Coverage and the considerations related to SUD care. The opportunity to uncover in-network and out-of-network negotiated contract rates can support the developing APM bundles and negotiating rates that fairly and sustainability reimburse providers.
The next virtual learning collaborative meeting is on May 24, from 3:00-4:30pm EST. For any questions or to join the conversation and connect with Alliance, please fill out this form and follow our public LinkedIn page.