Peer Recovery Supports & Services Payment Model for Substance Abuse
1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Faces and Voices of Recovery, on behalf of our member Recovery Community Organizations, is interested in what is the best payment model to use for peer recovery supports and services (PRSS) for individuals/adults in recovery from substance use.
Substance use/abuse and addiction represents an extremely significant health care burden in the United States. The Opioid Epidemic has had a devastating impact on the public health of our nation. In addition, the rise in use of alcohol and other substances in response to the stressors of COVID-19, will add to the social, economic and medical impact of opioid use.1
In addition, as a country, we are also facing a shortage in the behavioral health workforce.2,3 The traditional approach of providing treatment as the primary path to address addiction is expensive, with questionable outcomes.4 Peer recovery supports and services represent an effective approach to meeting these needs.5,6 However, the mismatch of payment mechanism to the PRSS model represents a barrier to recovery community organizations scaling up these services and building capacity to meet the need.
References
1. Covid-19 in Texas: An Analysis of Behavioral Health Needs to Advance Response Efforts, Texas Health Institute, Kenneth Smith, et al. September 28, 2020; Meadows Mental Health Policy Institute Covid-19 Response Briefings, Projected Covid -19 MHSUD Impacts, Volume 1; Effects of COVID-Induced Economic Recession-April 28 , 2020
2. Texas Statewide Behavioral Health Strategic Plan, 84th Legislative Session – 2015, Legislative Reports HB1.
3. Behavioral Health Workforce Projections, Health Resources & Services Administration, Dec. 2020.
4. DuPont, R. Creating a New Standard for Addiction Treatment Outcomes: A Report from the Institute for Behavior and Health, Inc. August 2014.
5. Report of Findings from a Systematic Review of the Scientific Literature on Recovery Support Services in the United States, Dr. John Kelly, Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, August 2017.
6. Perspectives on the Evolution and Future of Peer Recovery Support Services, RCSP, SAMHSA, 6/19/2013.
2. Why are you struggling with this issue?
The usual form of payment, fee-for-service, is based on a medical model of care, most often billed in 15-minute increments. PRSS is not a clinical service but is based on a social model of care.1 Similar to other peer-based models that address chronic illnesses, PRSS addresses the social determinants of health.2 PRSS provides person-centered, strength-based, self-determined care, as well as long-term engagement. The level of intensity of services needed reflects the point at which the individual is on their path to recovery and is not linear. Re-occurrence of use in not uncommon and requires flexibility in level of intensity of service. In-person, virtual, phone and texting are all key to providing successful supports, as are sober social and recovery community- based activities.
FAVOR needs an evidence-based approach to what other payment models, such as a bundled rate, or a value-based payment model, would be a better fit, if we are to build a financially stable national system, especially as we enter into contracts with health care payors in the coming years. What are the key factors associated with the models that are a better fit with PRSS? How should these models be implemented and structured? How can we best address risk? Trying to fit PRSS into a fee-for service payment model undermines the fidelity to the model and dis-incentivizes the very components that make it so effective in supporting recovery.
References
1. Recovery and Recovery Support. Substance Abuse and Mental Health Services Administration, US Department of Health & Human Services. April 2020.
2. Peer Support and Social Determinants of Health, Reports form 2019 Working Research Conference of the UM-UNC Peer Support Core at the Michigan Center for Diabetes Translational Research.
3. What do you want to see changed? How will you know that that your issue is improving or has been addressed?
We will see Recovery Community organizations use this information as they meet with health care payors and publicly funded agencies to negotiate contracts for providing peer recovery supports and services. RCO’s will meet with success in establishing payment models other than fee for service. Advocates will use this information to develop policies that better support individuals in recovery and support increased access to peer recovery supports and services delivered by RCO’s through financially sustainable recovery oriented systems of care.
4. When do you need the evidence report?
We would like the evidence report in one year.
5. What will you do with the evidence report?
Disseminate it to our members through our monthly all member meetings, through our policy alerts, through our newsletter and website and through our annual leadership meeting.
(Optional) About You
What is your role or perspective? Advocacy Coalition
If you are you making a suggestion on behalf of an organization, please state the name of the organization: Recovery Coalition of Texas
May we contact you if we have questions about your nomination? Yes
