The scale of the substance use disorder (SUD) crisis in the United States continues to shock the conscience—and defy containment. According to recent provisional data from the Centers for Disease Control and Prevention (CDC), overdose deaths are on track to surpass 101,000 in a single year. Opioids remain the leading cause of death, accounting for approximately 70% of all SUD-related fatalities since 2019. Value-Based Care in Addiction Treatment has emerged as a critical approach to addressing this crisis, focusing on improving outcomes and delivering effective, patient-centered care.
These statistics are not just numbers—they represent lives lost, families shattered, and communities devastated. Despite billions spent on services, the epidemic shows few signs of abating. Against this backdrop, policymakers and providers alike are looking for new strategies to shift the trajectory. One such effort comes from the Centers for Medicare & Medicaid Services (CMS), which launched an innovative pilot program designed to shift the SUD treatment model from fee-for-service to outcomes-based care.
Called the Value in Opioid Use Disorder Treatment Demonstration (ViT), the pilot program offers a pathway to value-based care in addiction treatment, rewarding providers for delivering holistic, effective, and evidence-based care—rather than simply billing for visits or procedures.
ViT: A new payment model for a complex problem
The CMS ViT program, launched in April 2021, offers a monthly care management fee of $125 per patient to enrolled providers. The payments are designed to support enhanced services such as medication-assisted treatment (MAT), peer recovery support, contingency management, and care coordination—services not always covered by traditional insurance reimbursement.
Performance-based incentives are also available, tied to patient health outcomes like reduced hospitalizations, treatment retention, and improved overall well-being. The program originally allocated $10 million in funding and selected 61 providers across 36 states and Washington, D.C., from among up to 20,000 applicants.
Crucially, ViT is not just a funding mechanism—it is a policy experiment with the potential to shape the future of value-based care in addiction treatment. By incentivizing meaningful outcomes rather than volume of care, CMS is seeking to change how the health care system approaches SUD recovery.
Iowa’s academic health system steps in
One of the participating providers is the University of Iowa (UI) Health Care, a major health system that serves patients across the Hawkeye State. While Iowa has not seen opioid overdose deaths rise as steeply as some other states, the problem is real and worsening. In 2020, opioid-related deaths rose by 35%—a troubling sign for a rural state already challenged by limited access to care.
Alison Lynch, a clinical professor and director of the Addiction and Recovery Collaborative at UI Health Care, emphasizes that geography, stigma, and a complex reimbursement environment all contribute to the state’s treatment access issues.
“People in Iowa are dispersed, and end up driving longer distances to get to a provider,” Lynch explained. “There is a lot of stigma around substance use disorders. And we believe that’s why many people don’t access treatment.”
According to Lynch, the ViT program gave her team a new mechanism to address those challenges by supporting a more comprehensive and proactive approach to recovery care. UI Health Care’s application specifically called for funding to expand access to MAT drugs like buprenorphine and increase care options through telehealth and outreach.
Thanks to the ViT stipend and performance incentives, UI Health Care has been able to:
- Hire additional case managers to provide patient follow-up and logistical assistance
- Employ paid peer support workers to offer lived-experience mentorship
- Expand its contingency management program, offering incentives to patients who meet specific recovery milestones
- Improve access to MAT across rural regions through telehealth delivery and expanded outreach
This multi-pronged, wraparound model is emblematic of value-based care in addiction treatment in action. Case managers, for instance, are now helping patients overcome insurance issues, schedule follow-ups, and stay engaged with care plans—all critical components of long-term recovery.
“Our case managers and our peer recovery support specialists help people monitor their goals,” Lynch said, “and then can help connect them with the incentive payment when they are successful in meeting those goals.”
Though UI Health Care’s ViT program currently has just six active participants, with 18 more eligible and screened, Lynch sees this as the beginning of a new way forward.
“We are totally thinking about the future,” she said. “This is just part of launching more of a proactive, compassionate, evidence-based approach to providing care to anyone who has substance use disorder.”
Cedar Recovery: Expanding the reach in Tennessee
In Tennessee, the need for innovative treatment models is even more pressing. The CDC’s data shows a 34% year-over-year increase in drug overdose deaths between June 2020 and June 2021—more than 10 percentage points above the national average. Tennessee has been especially hard-hit by the opioid epidemic, and Cedar Recovery has stepped up to meet the demand.
Cedar Recovery operates four treatment centers across the state, including its flagship clinic in Mt. Juliet, near Nashville. The organization provides MAT services using buprenorphine and integrates behavioral therapy into its programming. But according to Chief Strategy Officer Paul Trivette, the organization faced obstacles in covering all the services necessary for a holistic recovery model—particularly for Medicare patients.
“Over 80% of our patients are Medicare or Medicaid beneficiaries,” Trivette said. “But Medicare doesn’t cover all services necessarily needed for office-based opioid treatment. Nor do they reimburse for peer support, licensed marriage and family therapists, or contingency management.”
That’s why Cedar Recovery applied to ViT—and was accepted. With 62 patients already enrolled and plans to expand to at least 100 by the end of 2022, Cedar Recovery is fully leveraging ViT to deliver value-based care in addiction treatment that meets the full spectrum of patient needs.
Key changes made possible through ViT include:
- Employing peer support specialists through a contract with healthcare management firm Mindoula
- Integrating contingency management services, where patients earn prizes for achieving treatment milestones
- Partnering with Maury Regional Medical Center to offer addiction counseling across a broader geographic area
- Expanding access to Medicare patients previously underserved due to coverage limitations
Cedar Recovery’s contingency management model is as creative as it is impactful. Inspired by popular game shows, patients spin a prize wheel for rewards after meeting treatment benchmarks like attending therapy consistently or maintaining sobriety. Prizes range from hygiene products to food items—small, tangible rewards that can have a big impact on motivation.
“We can give them a treatment goal, and then say, ‘Hey, if you achieve this goal, you get to spin the wheel,’” Trivette said. “That just keeps them motivated.”
In terms of outcomes, Cedar Recovery’s early results are promising. Trivette reports a treatment retention rate of over 80% for ViT patients and notes there is no indication in the prescription monitoring system that these individuals have relapsed.
“Our members would say that our retention is good, our engagement is good,” Trivette said. “And we know that as long as we’re doing that, and these people’s lives are getting better … they’re staying alive to fight another day.”
Rethinking reimbursement: The broader promise of ViT
The early feedback from providers like UI Health Care and Cedar Recovery suggests that the ViT demonstration is doing more than just funding additional services—it’s encouraging a full cultural shift toward value-based care in addiction treatment.
In place of fragmented services and rigid billing structures, ViT allows providers to think holistically: combining medical treatment with behavioral support, community engagement, and practical incentives. The results are patient-centered and grounded in evidence—not just process metrics.
As CMS continues to monitor and evaluate the ViT pilot through its December 2024 end date, many in the behavioral health field are watching closely. If the initiative proves successful, it could serve as a model for future reimbursement reforms in addiction treatment—and even in behavioral health care more broadly.
For now, providers on the front lines remain focused on what matters most: saving lives and helping people heal.
“Ultimately, this is about outcomes,” said Lynch. “It’s about making sure that patients get what they need to not just survive—but to thrive.”
