CMMI Chooses 61 Participants for Value-Based Opioid Treatment Demonstration
The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation has chosen 61 organizations to participate in the 4-year Value in Opioid Use Disorder Treatment Demonstration, also known as the Value in Treatment Demonstration.
Starting this month, the demonstration project will test whether a new care management fee and performance-based incentive for opioid use disorder (OUD) treatment services can cut hospitalizations and improve health outcomes for individuals with OUD.
The demonstration will increase access to OUD treatment services, to improve physical and mental outcomes for eligible Medicare Fee-For-Service beneficiaries, including those dually eligible for Medicare and Medicaid, while reducing Medicare program expenditures to the extent possible.
The demonstration creates two new Medicare payments for participating providers and suppliers — a per-beneficiary, per-month care management fee and a performance-based incentive payment. Participants can use these additional payments for patient-centered OUD treatment services expected to result in improved outcomes and cost savings among people with health and social needs that go beyond the clinical services that Medicare currently covers.
The selected applicants include physicians, hospitals, health centers, treatment programs, and more. They are enrolled Medicare providers, practitioners and suppliers that have an OUD care team to give or arrange for OUD treatment services in the outpatient setting.
CMS will evaluate several quality indicators as part of this demonstration: Retention in treatment, reduction in emergency department (ED) utilization, use of pharmacotherapy for OUD, follow-up after an ED visit for alcohol and other substance use or dependence, and initiation and engagement of alcohol and other drug dependence treatment.
One of the participants is Cedar Recovery LLC, a provider of outpatient addiction treatment in Tennessee. Its executives pointed to the value of medication-assisted treatment (MAT) for opioid and/or alcohol use disorder(s), which combine FDA-approved medication(s) such as Buprenorphine (commonly known by its trade name as Suboxone) or Naltrexone with counseling and case management services. "This program is a valuable step in continuing to reduce stigma surrounding addiction and MAT as a treatment. I have treated hundreds of patients over the last 10 years and MAT is the most effective modality I have seen. Now, we get to prove it really works," said Stephen Loyd, M.D., chief medical officer of Cedar Recovery, in a statement.
The demonstration is authorized under section 1866F of the Social Security Act, which was added by section 6042 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which makes available $10 million from the Federal Supplementary Medical Insurance Trust Fund for each of fiscal years 2021 through 2024 to pay participants for Value in Treatment services.
