Addiction to opioids, alcohol, and other drugs have devastating individual and family effects and too often end lives prematurely while driving enormous inefficiency in health care. Unlike many other chronic conditions — where “standards of excellence” inform consumers, health systems, and payers about best practices and services that should be available — today’s recovery services are delivered through a method often lacking alignment or integrated economic structures that incentivize long-term recovery.
In late 2016, the U.S. Surgeon General issued the seminal “Surgeon General’s Report on Alcohol, Drugs, and Health: Facing Addiction in America.” The report issues a call for mainstream health systems to begin integrating substance use services was afforded an entire chapter. In response, organizations have formed the Alliance for Addiction Payment Reform (Alliance) to:
Provide guidance, recommendations, and tools for the development of integrated delivery models of care for addiction;
Collectively champion payment reform and shifting towards value-based purchasing in addiction care; and
Advance value-based models nationally through private and public channels.
The Alliance, comprised of dozens of health care institutions and professionals, developed the Addiction Recovery Medical Home Alternative Payment Model (ARMH-APM) to establish a structure that promotes the type of integration and patient care capable of producing improved outcomes for patients, payers, and health systems long-term by aligning all incentives. The ARMH-APM was initially developed by a multi-sector process convened by Leavitt Partners, Facing Addiction with NCADD, and Third Horizon Strategies and published in 2018. In 2019, Third Horizon Strategies continued to manage the work on behalf of the Alliance and released an updated paper coinciding with the announcement of pilot explorations of the model in local markets.
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The ARMH-APM is built on five key elements that represent its most foundational principles. The model itself was established in a commercial context, with high deference for adopting payers and providers to develop situation and population specific applications.
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).
Drawing from best current practices in the field, ARMH-APM pilot demonstrations will refine entry and participation criteria for providers. The pilot will also develop both process and outcomes measures that will tie the provision of care to payment, incenting recovery and informing a national baseline of long-term substance use disorder performance metrics.
Integrated Treatment & 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.
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 protocols and requirements for the team’s engagement with the patient, focused on sustaining interaction and support through the patient’s recovery journey.
Treatment & Recovery Network
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). derived from a myriad of different health care, social, and economic sources. 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.