Outcomes data has been positioned as both the key to value-based care and the most effective leverage for substance use disorder (SUD) providers when negotiating with payers. The idea is straightforward: by demonstrating tangible results, providers can showcase the efficacy of their treatment programs and convince payers to invest in care models that focus on long-term recovery rather than just short-term interventions. However, as industry insiders discussed at the Behavioral Health Business INVEST conference, while some providers have begun to see success with this approach, many still face significant hurdles in both acquiring and effectively utilizing outcomes data in SUD treatment.
Providers’ Experiences with Outcomes Data
A handful of progressive SUD providers have experienced firsthand how outcomes data in SUD treatment can help make payer negotiations more productive. Masroor Ahmed, CEO of Symetria Recovery, shared his experience of seeing payers begin to take outcomes data seriously, particularly when it highlights positive metrics such as retention rates. Symetria Recovery, which operates 13 SUD treatment facilities in Illinois and Texas, integrates services like medication-assisted treatment (MAT), mental health care, and intensive outpatient programs (IOPs). According to Ahmed, presenting outcomes data in SUD treatment that shows successful treatment outcomes and reduced relapse rates can be a compelling factor in payer negotiations, as it underscores the long-term cost savings that come with effective, early intervention and consistent care.
The Challenges in Acquiring and Using Outcomes Data
Despite these success stories, the reality for many providers is that acquiring and presenting meaningful outcomes data in SUD treatment is not as easy as it sounds. While payers may claim to value data, the process of gathering this data, especially in a format that directly impacts negotiations, can be cumbersome. Ahmed highlighted that, although there have been some positive results, “everything’s moving at a snail’s pace.” He attributed this slow progress to the outdated technological systems and legacy structures of many payers, which can impede the swift implementation of value-based care initiatives. Even after providers gather the data, the challenge becomes whether that data will move the needle significantly in payer negotiations, which remain heavily influenced by payer priorities and existing policies.
Payer Relationships and Inaccurate Data
Roy Serpa, chairman of the board and co-owner of T&R Recovery Group, was even more candid about his concerns regarding the value placed on outcomes data by payers. He explained that, in his experience, many payers give “lip service” to the importance of outcomes data in SUD treatment but often fail to act on it meaningfully. “Sometimes they have their own outcomes of your data,” Serpa said, noting that providers often receive data from payers that is inaccurate or misleading. For instance, payers may misinterpret or mishandle the data, leading to discrepancies in what is considered successful treatment. “So you need to challenge that with your own data and put it up side by side with them and show them,” Serpa advised. This creates an additional layer of complexity for providers who already face a challenging landscape. T&R Recovery, which operates facilities in Arizona, Florida, and Texas, specializes in treating SUDs, mental health issues, and trauma. Serpa stressed that having the right data and being prepared to challenge inaccurate data from payers is crucial in any negotiation.
Developing a Strong Payer Strategy
In light of these challenges, providers must develop a comprehensive payer strategy, which can be especially difficult for smaller providers. Ahmed described it as a “David and Goliath” situation, with smaller providers often struggling to acquire the necessary data to compete with larger, well-funded organizations. These smaller providers may lack the resources, technical infrastructure, and data analytics capabilities that would allow them to capture meaningful outcomes data in SUD treatment. For these organizations, gathering and presenting compelling outcomes data can feel like an uphill battle, and some may question whether the effort is worth the return on investment if payers are not responsive to the data presented.
The Future of Value-Based Care in SUD Treatment
Despite these challenges, the push for outcomes data in SUD treatment is undeniably critical for the future of value-based care. As providers look toward the future, many are divided on how actionable these value-based care models really are. Josh Scott, CEO of Guardian Recovery, shared his thoughts on the potential of value-based care, acknowledging its promise but also pointing to operational challenges when trying to implement alternative payment arrangements with payers. Guardian Recovery, based in Delray Beach, Florida, operates 17 physical treatment clinics and a virtual care option. Scott’s company is planning to double in size over the next two to three years. While he agrees that payers are genuinely interested in outcomes data in SUD treatment, he pointed out that many of them lack the necessary infrastructure to fully support value-based models. “Value-based models haven’t caught up with capabilities and back office infrastructure and administrative capacity from payers,” Scott explained. He emphasized that the responsibility for making this shift lies largely with providers who must actively work to build stronger relationships with payers and push for more meaningful data-driven decisions.
Strengthening Relationships with Payers
In fact, developing stronger partnerships with payers is a top priority for Guardian Recovery in the coming years. Likewise, Serpa noted that understanding and addressing payer needs is one of the most pressing issues for treatment providers today. Building these relationships is essential for providers to gain a foothold in the value-based care landscape. It’s clear that payers and providers must work in tandem to address the gaps in infrastructure and technological readiness that currently hinder the widespread adoption of value-based care models in the SUD treatment space.
Investing in Quality Care Practices
The larger takeaway from the discussions at the INVEST conference was the recognition that value-based care has enormous potential but requires a paradigm shift in both the way payers and providers approach treatment. While it’s easy to get caught up in the complexities of payer negotiations and the challenges associated with gathering outcomes data in SUD treatment, providers are urged to remain focused on providing quality care. As Ahmed pointed out, investing in quality care practices, even those that may not be immediately reimbursable at the moment, is a crucial long-term strategy for growth. “The elephant in the room is: half of the folks who enter treatment, between three, four, five, six months, are no longer in treatment,” Ahmed said, emphasizing the importance of understanding why patients drop out of treatment early and developing strategies to keep them engaged.
Conclusion: A Data-Driven Future for SUD Treatment
Ultimately, the success of outcomes data in SUD treatment negotiations will depend on providers’ ability to develop robust data collection systems, present compelling evidence of their treatment effectiveness, and build strong, collaborative relationships with payers. Although the road ahead may be long, those providers who invest in patient care and data collection today will be better positioned to take advantage of value-based care models in the future. As the industry evolves, the partnership between providers and payers will be essential in driving positive, long-term outcomes for individuals seeking recovery from substance use disorders.
