The landscape of addiction treatment is undergoing a transformative shift toward value-based care, a model that prioritizes patient outcomes and cost efficiency over the traditional fee-for-service system. This shift is driven by the need to improve long-term recovery rates, reduce relapse, and manage healthcare spending effectively. Across the United States, several leading providers are pioneering this approach, forging innovative partnerships with payers, and leveraging data-driven strategies to enhance care quality. This article explores six influential addiction treatment organizations advancing value-based care addiction treatments and their impact on the industry.
Eleanor Health: A Data-Driven Pioneer in Value-Based OUD Treatment
Founded in 2019 and headquartered in Waltham, Massachusetts, Eleanor Health quickly positioned itself at the forefront of value-based care addiction treatments. As one of only 61 providers selected for the Centers for Medicare & Medicaid Services (CMS) New Value-Based Opioid Use Disorder (OUD) Treatment Demonstration in 2021, Eleanor Health is recognized for its commitment to innovative care delivery.
Since its inception, Eleanor has raised significant funding to support its growth and platform development, including a $50 million financing round in April 2022. The organization operates 28 clinics across six states and partners with major payers such as Point32Health and Amerigroup Washington. These partnerships allow Eleanor to implement population-based approaches that emphasize quality outcomes, patient satisfaction, improved access, and reduced costs.
Corbin Petro, CEO and co-founder of Eleanor Health, highlights the importance of tangible data when engaging with payers:
“When we go to payers and talk to them about a population-based approach, we come with the data that we have achieved in our care model; we come with quality outcomes, access outcomes, satisfaction outcomes, and cost outcomes.”
Eleanor’s model demonstrates how combining clinical expertise with robust data analytics can reduce the total cost of care while improving treatment retention and patient outcomes. This approach has led to strong, value-based partnerships, exemplifying the potential of data-driven addiction treatment. Their commitment to value-based care addiction treatments positions them as a key innovator in the field.
Groups Recover Together: Driving Retention Through Performance-Based Care
Founded in 2014 and based in Burlington, Massachusetts, Groups Recover Together has expanded rapidly to serve patients across 15 states, with plans to grow into nine additional states. Groups specializes in treating opioid use disorder (OUD) using a performance-based business model rather than traditional fee-for-service or private pay.
The company recently raised $60 million in Series C funding to fuel its national expansion and broaden its service offerings. Groups’ model holds the organization accountable not just for delivering services but for maintaining patient retention and managing costs effectively.
Cooper Zelnick, Chief Revenue Officer of Groups Recover Together, shared key retention statistics at the Behavioral Health Business VALUE conference:
“Groups Recover Together sees six-month retention rates of 68% for Medicaid patients and 75% for commercial health insurance patients. The industry average for six-month retention in substance use disorder treatment is between 25% and 30%.”
These impressive retention figures highlight the effectiveness of Groups’ performance-based approach and its commitment to long-term recovery success. By aligning financial incentives with patient outcomes, Groups fosters accountability and delivers better value for both payers and patients through their value-based care addiction treatments.
Caron Treatment Centers: A Legacy Provider Embracing Value-Based Care
Caron Treatment Centers, headquartered in Wernersville, Pennsylvania, brings over six decades of experience to the addiction treatment landscape. As a not-for-profit provider, Caron has long been committed to comprehensive substance use disorder (SUD) care and innovation.
In 2017, Caron embarked on a pioneering three-year pilot program implementing a value-based payment model in collaboration with Independence Blue Cross (IBC). The pilot yielded remarkable results: among 71 IBC beneficiaries treated by Caron, the 90-day relapse rate was less than 6%, significantly lower than the 12% to 26% readmission rates seen across other providers in IBC’s network.
Brad Sorte, who became Caron’s CEO in 2021, is a vocal advocate for value-based care addiction treatments as the future of addiction treatment. Speaking at Behavioral Health Business, Sorte stated:
“Value-based care puts the onus on the provider to raise their standard of care. But the long-term effect of raising the standard of care will eventually be better outcomes for the patient, lower costs for the payer, and hopefully, better reimbursement.”
Caron’s experience underscores the potential of value-based arrangements to drive higher quality care and more sustainable financial models in addiction treatment. Their success provides a strong example of the benefits that value-based care addiction treatments can bring to patients and payers alike.
Oceans Healthcare: Outcome Measurement as a Quality Catalyst
Based in Plano, Texas, Oceans Healthcare has grown since its founding in 2004 from a behavioral health provider for older adults to a comprehensive network spanning 33 locations and 23 hospitals, serving approximately 24,000 patients annually.
In 2019, Oceans Healthcare adopted the Patient Health Questionnaire-9 (PHQ-9), a standardized tool for measuring depression severity, as part of its commitment to evidence-based outcome measurement. Melynda Boothe, Executive Vice President of Process Improvement and Outcomes, stresses the value of PHQ-9 assessments in supporting providers transitioning to value-based care:
“PHQ-9 assessments can be ideal for providers interested in value-based care because they help constantly assess the quality of services rendered.”
Supported by an investment from Webster Equity Partners, Oceans has expanded into Texas, Louisiana, and Oklahoma in recent years. CEO Stuart Archer emphasized the organization’s ongoing dedication to quality:
“We remain dedicated to quality inpatient care and are among the industry’s leaders in defining quality metrics.”
Oceans Healthcare’s approach highlights the critical role of reliable outcome measures in driving continuous improvement and meeting value-based care expectations. Their focus on outcomes is a key component of effective value-based care addiction treatments.
Spero Health: Addressing Operational Challenges in Value-Based Care
Spero Health, headquartered in Nashville, Tennessee, specializes in outpatient treatment for substance use disorder, operating over 70 freestanding clinics across Kentucky, Ohio, Indiana, Virginia, and Tennessee. Since 2021, the organization has opened several new locations to broaden its reach.
At the Behavioral Health Business VALUE conference, CEO Steve Priest acknowledged both the potential and the hurdles of implementing value-based arrangements in addiction treatment:
“Value-based arrangements couldn’t be operationalized because payers’ systems are built only for fee-for-service businesses.”
Priest highlighted that substance use disorders are chronic in nature, making them particularly well-suited for value-based care models focused on long-term outcomes. However, the current payer infrastructure often limits the ability to fully realize these arrangements.
Despite these challenges, Spero Health remains committed to advocating for system reforms that can facilitate a shift toward payment models better aligned with patient needs and recovery goals. Their efforts reflect ongoing challenges and promise within value-based care addiction treatments.
The Road Ahead: Value-Based Care as the Future of Addiction Treatment
These six organizations exemplify the growing momentum toward value-based care addiction treatments within the addiction treatment sector. From innovative startups like Eleanor Health and Groups Recover Together to legacy providers such as Caron Treatment Centers, the industry is embracing models that prioritize measurable outcomes, sustained patient engagement, and cost control.
Success in value-based care hinges on robust data collection, meaningful partnerships with payers, and the ability to navigate complex operational challenges. While barriers remain, particularly around payer systems and reimbursement structures, the demonstrated improvements in retention rates, relapse reduction, and cost savings offer a compelling case for widespread adoption.
As value-based care addiction treatments continue to evolve, addiction treatment providers that can effectively integrate outcome measurement, foster payer collaboration, and focus on holistic patient recovery will lead the way toward a more sustainable, patient-centered future.
