Utilizing value based payment to transform Opioid Use Disorder (OUD) treatment ecosystem


Though medication assisted treatment (MAT) is the known evidence-based treatment for individuals with opioid use disorder (OUD), utilization remains low. To connect individuals with OUD to appropriate care, more high quality MAT providers are necessary. Individuals experience their lives across complex and fragmented sectors. To better align resources for these members in the community, we have created targeted micro-incentive payment models to enable providers to deliver comprehensive, evidence-based OUD treatment where people already receive care (PCP, OB-GYN). These payment models not only directly fund evidence-based treatment and related supports, but through this funding, we also seek to build additional capacity at the provider level. 

MAT Retention Model

Incentive Design

Expected results

Increased number of members receiving and being retained on MAT

Increased number and capacity of providers practicing evidence-based MAT

Care management activities include:

  • Conduct comprehensive assessment on physical, behavioral, and social needs and case severity. 
  • Create and support an individualized Addiction Treatment and Recovery Plan 
  • Provide coordination to help individuals overcome barriers to care, and improve overall health, including providing treatment for other co-occurring physical or behavioral conditions and connecting to psychosocial supports and social service providers.
  • Educate on harm reduction including providing a naloxone prescription
  • Provide reproductive health counseling and family planning options to women of child-bearing age
  • Perform random drug urine screens
  • Screen for HIV, Hepatitis B, Hepatitis C, and pregnancy

Status: Implemented 12.1.19

Maternal Infant Health Home Model

Prenatal Incentive Design

*Based on adherence thresholds

Postpartum Dyad Incentive Design

Expected results

Increased number of members receiving and being retained on MAT

Reduce severity of NAS and NICU length of stay

Stably maintain mom/baby dyad with treatment & recovery supports

In addition to care management activities required in the MAT retention model, additional maternal and infant-related services required

Status: Prenatal Portion Implemented 1.1.20

Not eligible for postpartum until 3.1.20. Currently collaborating on postpartum dyad reporting given that Summa does not furnish pediatric care. 

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