Health plans across the nation are increasingly recognizing the significant impact that substance use disorder (SUD) has on the overall health system and its costs. Data shows that members living with SUD typically incur total healthcare costs three to four times higher than those without SUD. This cost disparity stems from increased hospitalizations, emergency room visits, comorbid physical and behavioral health conditions, and complex social needs. At the same time, the cost of SUD treatment itself is rapidly rising, further challenging health plans to find cost-effective approaches without compromising quality of care. These factors are driving a rapid transition toward value-based care for substance use disorder, where payments and incentives are tied to outcomes rather than individual services. Value-based care encourages providers to deliver more coordinated, comprehensive, and patient-centered care that leads to lasting recovery, while also helping health plans manage their total cost of care more effectively.
Greg Williams, Managing Director of Third Horizon Strategies and Co-Founder of the Alliance for Addiction Payment Reform, recently shed light on the critical challenges and opportunities during a BHB Tech Talks virtual discussion. “We need to find ways and pathways to link SUD care across disparate parts of the current services,” he said. Currently, SUD treatment is often fragmented, with disconnected services and gaps in care that can undermine patient progress. The transition to value-based care for substance use disorder presents an opportunity to realign incentives so providers are motivated to coordinate care holistically across the entire continuum.
Why Value-Based Care for Substance Use Disorder Matters
Traditional fee-for-service payment models often reward volume over value. Providers get paid based on individual treatments or visits, with little focus on long-term outcomes or patient engagement beyond the clinical setting. This system can encourage fragmented care, short-term interventions, and minimal support between visits.
In contrast, value-based care for substance use disorder incentivizes providers to focus on the overall recovery journey. Instead of buying isolated “point solutions,” Williams emphasizes the need to “buy a constellation of services” that collectively support a person’s recovery. This approach encourages collaboration among a diverse set of care providers who together address the complex and varied needs of individuals with SUD.
For health plans, this means adopting payment models that reward positive outcomes such as sustained abstinence, reduced hospitalizations, improved quality of life, and successful integration into community life. These models can help contain costs while improving patient experience and long-term recovery success.
Key Principles for Supporting Patient Recovery Under Value-Based Care for Substance Use Disorder
To succeed in this new landscape, behavioral health care providers should consider several key principles:
- Involve a Wide Array of Providers Across the Continuum
SUD care must be delivered by a broad network of professionals. This includes credentialed SUD specialists, peer recovery coaches who bring lived experience, care coordinators, primary care doctors, and behavioral health clinicians. Each plays a unique role in addressing clinical needs, social determinants of health, and ongoing recovery support.
Moreover, SUD care often requires connections with other health-related services, such as dental care, pharmacy, and mental health treatment. Integrating these services ensures patients receive comprehensive care tailored to their individual needs, reducing fragmentation and improving outcomes.
- Deliver the Right Care at the Right Time
Timing is crucial in recovery. Williams points out the importance of tracking patients continuously to ensure they access the “right people at the right time” with recovery support available 24/7. Relapse can happen quickly and unexpectedly, and patients need timely interventions and encouragement.
Technology is a key enabler in this effort. Digital tools can provide real-time monitoring, reminders, peer support, and immediate access to resources that keep patients engaged and supported outside traditional office hours. This helps prevent gaps in care that may otherwise lead to relapse.
- Close Critical Care Gaps Between Visits
Even when individuals are enrolled in Intensive Outpatient Programs (IOP) or outpatient treatment, care gaps between visits can last days or weeks. These intervals are often vulnerable periods where patients may struggle without adequate support.
Providers need to proactively solve for these gaps by offering continuous engagement and recovery resources during these times. Again, technology is indispensable here, offering 24/7 access to support networks, therapeutic tools, and crisis intervention capabilities that complement in-person care.
How Technology Accelerates Success in Value-Based Care for Substance Use Disorder
Technology plays a dual role in supporting value-based care for substance use disorder treatment:
Integrated Platforms Linking Multi-Stage Care
Platforms such as CHESS Health’s multi-dimensional system enable providers to connect and track all stages of a patient’s treatment and recovery journey. Instead of viewing treatment as isolated episodes, these platforms allow the entire care continuum—including detox, inpatient, outpatient, recovery support, and social services—to be managed as a single, integrated experience. This holistic view improves coordination, reduces redundancy, and ensures that providers have up-to-date information to make informed decisions.
Continuous Patient Engagement and Recovery Support
CHESS Health’s eRecovery solution exemplifies how patient engagement technology can offer crucial 24/7 recovery support. Through smartphone apps, peer support teams, and care management tools, individuals receive ongoing encouragement and resources to stay engaged in treatment, manage cravings, and maintain progress between clinical visits.
This constant connection helps reduce dropouts, promotes adherence to treatment plans, and ultimately supports long-term recovery success—key goals of value-based care for substance use disorder models.
A Collective Effort Across the Healthcare Continuum
Improving outcomes for individuals with substance use disorder requires a coordinated effort beyond just providers and health plans. Morefield from CHESS Health sums it up: “Helping individuals succeed in long-term recovery is something we all care about across the healthcare continuum.”
Health plans, providers, community programs, public agencies, friends, and family all play essential roles in supporting recovery. Value-based care for substance use disorder, supported by innovative technology and integrated provider networks, offers a promising path to better outcomes for patients and more sustainable costs for health plans.
As the healthcare system continues to evolve, embracing these principles and technologies will be critical in transforming SUD treatment from fragmented, episodic care into a continuous, patient-centered journey toward lasting recovery.
