Peer Support Services are emerging as a transformative force in the behavioral health field, with increasing recognition and adoption across the United States. What was once seen as a niche approach is now gaining widespread attention, thanks to a combination of federal initiatives, new reimbursement opportunities, and the fallout from the opioid crisis. These services, led by individuals who have lived through mental health and substance use disorders, offer unparalleled value in promoting recovery and patient engagement, making them a key component in the shift from fee-for-service models to value-based care.
At the forefront of this movement is the growing body of evidence supporting the effectiveness of Peer Support Services. This model is based on the idea that individuals with lived experience of behavioral health challenges can offer unique insights and guidance to others who are in similar circumstances. As Shrenik Jain, founder and CEO of Marigold Health, shared at the Behavioral Health Business (BHB) VALUE conference, “Pretty much every person who is getting treatment for a mental health or substance use condition will benefit from peer support.” This sentiment echoes across the industry, with providers recognizing the crucial role peers play in driving sustained patient engagement and promoting long-term recovery.
What Is Peer Support and Why Is It So Effective?
Peer Support Services are led by individuals who have personal experience with behavioral health conditions and have navigated their own recovery journey. These individuals are not clinicians or therapists; rather, they offer emotional support, encouragement, and practical advice based on their own lived experiences. Peer Support Services help individuals set goals, discover their strengths, and remain motivated as they move through their recovery process. Importantly, they do not provide medical diagnoses or clinical treatments—rather, they serve as mentors, guides, and companions in the recovery journey.
Dr. Kim Newell Green, co-founder and chief medical officer of Flourish Labs, explained the power of Peer Support Services at the BHB VALUE conference, saying, “Peer supporters say, I have been there in your shoes, and I know that you can recover. I know that you have everything you need inside of you. So let’s figure out what your strengths are, set some goals, and I’m going to be alongside you as you walk this path towards recovery.” This approach helps individuals feel understood, validated, and empowered, all of which are crucial for fostering recovery.
Flourish Labs, like other organizations in the peer support space, has embraced technology as a means of scaling this model. The organization trains young adults to become certified peer support specialists, who are then paired with teens in need of support. By leveraging both peer mentorship and technology, Flourish is expanding access to Peer Support Services, especially for younger populations who may not otherwise have this type of guidance.
Peer Support and the Shift Toward Value-Based Behavioral Health Care
Peer Support Services are a critical component of the broader shift toward value-based care in behavioral health. Value-based care is a system where providers are reimbursed based on the quality of care they provide and the outcomes achieved, rather than on the volume of services rendered. This model encourages providers to focus on long-term recovery, patient engagement, and overall well-being, as opposed to the traditional fee-for-service model, which often emphasizes the number of treatments or interventions provided.
Dana Foglesong, national senior director of recovery and resiliency services at Magellan Healthcare, emphasized the role of Peer Support Services in value-based care, noting, “Peers are a valuable resource for providers to drive value, not just because of the evidence supporting their effectiveness.” Peer specialists are often quicker to train and more cost-effective than licensed clinicians, yet they provide high-quality support that can enhance patient outcomes. This makes them a valuable asset in a value-based care system, where the focus is on achieving positive outcomes for patients while keeping costs manageable.
Marigold Health, a leader in the peer support space, operates on a case rate model, which is more aligned with value-based care than the traditional fee-for-service model. Under the case rate model, peers are primarily responsible for engaging patients and keeping them involved in their care over time. This model allows providers to better capture the full value of Peer Support Services, as it accounts for the ongoing, personalized efforts that peers put into maintaining patient engagement. Jain pointed out that traditional fee-for-service models do not fully recognize the time and effort invested by peers in connecting with patients before, during, and after treatment. He noted, “Whereas on the day rate, that continuous work to keep someone sticky in a personalized way [is reimbursable],” underscoring the value of long-term engagement in recovery.
While Peer Support Services are still primarily reimbursed under fee-for-service arrangements, there is growing momentum behind the adoption of value-based models. Jain and other industry insiders believe that there is a significant opportunity to expand the use of Peer Support Services in value-based arrangements, which can improve patient outcomes while reducing costs. “In many ways, they are a faster workforce to train, maybe a little bit less expensive than some of the more licensed providers and can provide incredibly high-quality work,” Jain explained. As more providers move toward value-based care, Peer Support Services are becoming an increasingly important part of the equation.
The Growing Adoption of Peer-Based Models
The adoption of Peer Support Services has grown significantly over the last five years, spurred in large part by the opioid crisis. As the crisis has unfolded, millions of dollars in federal and state funding have flowed into programs aimed at expanding the substance use peer support workforce. The Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized peer support as a best practice and is actively supporting its integration into behavioral health programs across the country.
Certification processes for peer specialists have been implemented in every state, and Medicaid now reimburses for Peer Support Services in 35 states. This growing recognition has created new opportunities for peer support providers, who can now access reimbursement for their services, making it more feasible for them to scale their programs. Jain highlighted Marigold’s rapid expansion as evidence of the growing acceptance of Peer Support Services, saying, “Two years ago, we were operating in a single state, and now we’re operating in half a dozen states.”
In addition to state-level efforts, the Biden-Harris administration has put significant emphasis on building a national mental health strategy that includes a commitment to developing a national certification program for peer specialists. This initiative is designed to promote the universal adoption, recognition, and integration of Peer Support Services into behavioral health programs across the country.
Challenges and Opportunities in Scaling Peer Support
Despite the progress made in expanding Peer Support Services, there are still barriers to fully leveraging peers in the behavioral health industry. One of the biggest challenges is the lack of a unified, national certification standard for peer specialists. As Dr. Green pointed out, “It would be much easier for companies offering Peer Support Services if there was a single national certification standard, rather than each state having its own process.” This lack of consistency can create inefficiencies and confusion for organizations that want to expand their peer support programs across state lines.
Another challenge is that many providers have not yet figured out how to effectively integrate peer specialists into their existing care models. Jain emphasized that providers must understand how to operationalize a peer workforce, particularly when serving large Medicaid populations. Understanding the nuances of state Medicaid waivers and the reimbursement models for Peer Support Services is crucial for providers to successfully implement this model.
The Future of Peer Support: A Cost-Effective Solution for Behavioral Health
The future of Peer Support in behavioral health is bright, with increasing adoption and recognition at both the state and federal levels. As the behavioral health care system shifts toward value-based care, Peer Support Services are poised to play an even more significant role in patient engagement, long-term recovery, and overall care outcomes. Peer specialists provide a unique and cost-effective solution for providers seeking to improve patient outcomes while controlling costs.
For providers, integrating Peer Support Services into their care models offers a win-win: it enhances patient engagement, improves recovery outcomes, and helps reduce overall healthcare costs. As reimbursement models continue to evolve and the demand for scalable, effective care delivery models grows, Peer Support Services will become an even more integral part of the behavioral health care landscape.
In conclusion, Peer Support Services are not just a trend but a fundamental shift in how behavioral health care is delivered. With continued federal support, new reimbursement opportunities, and growing recognition of their effectiveness, peer specialists are set to play an essential role in the future of value-based care. The industry is on the verge of a major transformation, and Peer Support Services will be a key driver of that change.
