Addiction Recovery Medical Home - Alternative Payment Model
Incentivizing Recovery. Not Relapse.
Drug overdoses have become the leading cause of death in America for those under 50, while addiction to alcohol remains even more prevalent than opioids. The death toll continues to rise in spite of the existence of a more than $35 billion industry attempting specialty addiction treatment today. The problem is our health care systems have largely deployed an acute infectious disease-like response to what is definitively a chronic health problem. Or worse, many mainstream healthcare institutions haven’t responded at all.
The landmark Surgeon General’s Report on Alcohol, Drugs, and Health, Facing Addiction In America, synthesizes decades of research and clear protocols about what works in intervention, treatment, and recovery support. The report includes a robust call-to-action to integrate and coordinate addiction health services across a long-term continuum of care similar to other chronic disease models.
The Addiction Recovery Medical Home Alternative Payment Model (ARMH-APM) is a consensus learning model developed by dozens of healthcare institutions and professionals, representing an attempt to establish a structure that promotes the type of integration and patient care capable of producing improved outcomes for patients, payers, and health systems by aligning all incentives. This group organized the Alliance for Recovery-Centered Addiction Health Services (Alliance) to further promote the approach, pilot it in various markets, evaluate outcomes, and refine the model over time.
Addiction Recovery Medical Home Components
The ARMH-APM is built on five key elements that represent its most foundational principles. The model itself was established in a commercial context and is initially targeting Medicaid managed care and large employer health plans, with high deference for adopting payers and providers to develop situation and population-specific applications.
Element #1 – Payment
At the core of the ARMH-APM is a multi-faceted payment model that carves out financial resources for addiction treatment and recovery services. The nature of this payment and its underlying calculation transcend three different often overlapping phases of a patient’s recovery, beginning with Pre-recovery and Stabilization (less than 30 days), Recovery Initiation and Active Treatment (0-12 months), and Community-Based Recovery Management (0-5 years).
Element #2 – Quality Metrics
Given the current non-existence of long-term quality measure for substance use disorders, the Alliance has partnered with the National Committee for Quality Assurance (NCQA) to pursue the development of quality measures that can more accurately reflect patient outcomes and performance in the future.
Element #3 – Integrated Treatment and Recovery Network
Critical to the success of the ARMH-APM is the establishment of a network that wires key clinical resources with broader community assets that can support the patient’s multi-year recovery journey. These entities should be contracted with or owned by the sponsoring risk-bearing provider and operate on common information systems used to share clinical information and better manage discharges and care transitions.
Element #4 – Care Recovery Team
Team-based care is a critical feature to managing any chronic disease. The ARMH-APM Care Recovery Team requires a care coordinator, a para-professionally trained peer recovery coach, behavioral health specialists, licensed counselors, and primary care professionals. The model establishes engagement protocols and requirements for the nature of this team’s engagement of the patient, focused on sustaining interaction and supports through the patient’s recovery journey.
Element #5 – Treatment and Recovery Plan
All recovery-oriented systems of care should be focused on building a patient’s recovery capital (similar to concepts surrounding of social determents of health). This capital derived from a myriad of different sources, most of which transcend health care and focus on various social and economic determinants. The ARMH-APM adopts a planning structure that includes 12 key recovery dimensions and advances specific guidelines on structuring treatment and recovery planning in collaboration with the patient.
Within the ARMH-APM framework, providers and payers are encouraged and incentivized to tailor the approach to the needs of each patient. That means complete abstinence from all substances may not be an initial recovery goal for many patients and the care team is positioned to meet people where they are and move that patient along a journey toward improved wellness while reducing emergent risk factors.
In late 2016, the U.S. Surgeon General issued the seminal report on Alcohol, Drugs, and Health: Facing Addiction In America. In the report, a call for mainstream health systems to begin integrating substance use services was afforded an entire chapter. These background videos were recorded at the launch of this report and provide additional context on the most current science, and evidence for which the ARMH-APM is grounded in.
Facing Addiction in America Summit
Press Releases and News Links:
Press Release: New Healthcare Alliance Launches Alternative Payment Model for Addiction Recovery – 9/7/18
Fierce Healthcare: Healthcare group unveils payment model aimed at integrating addiction treatment into medical care
U.S. Surgeon General: We need to continue to partner together & work together to #IncentivizeRecovery
1 in 3 households in American have been directly impacted by a substance use disorder. Despite the prevalence, other medical conditions are not surrounded by as much negative public attitudes and misunderstanding as substance use disorders.