At the Inspire Recovery conference, payers and providers align on needed substance use disorder strategies.
In the healthcare industry, if mental health lags behind medical care, then substance abuse disorder (SUD) lags behind both.
Payers and providers alike acknowledge this. They're also coming together to do something about it. One example is the Inspire Recovery conference, held April 5, 2023, in Nashville, Tennessee, at the Country Music Hall of Fame.
Across four sessions, common and critical SUD themes emerged:
- The importance of evidence-based treatment and outcomes measurement
- Infrastructure, funding, and reimbursement, all of which are lacking
- SUD strategy and treatment for future decades, not past ones
- Patient access, engagement, and the value of peer support and lived experience
- The importance of multi-stakeholder commitment
All form the patchwork that is SUD treatment in the United States. Technology and collaboration are working to connect the pieces without leaving the most important one behind: the human beings struggling with addiction who don't know where to turn, who may believe the only treatment option they have is leaving their lives for 30 days of inpatient care, and who may be addicted to substances they don't even know they're taking due to the rise of synthetic drug lacing.
Conference and session details
The Inspire Recovery conference included panelists and audience members from payer, provider, startup, and venture capital organizations. The event included three sponsors, whose executives served as panel participants:
- Wayspring, which provides SUD, behavioral health, and primary care services in partnership with health plans
- Groups Recover Together, which also provides SUD treatment, including group and custom support also in concert with payers
- Going Digital: Behavioral Health Tech, a mental health innovation community created by founder and CEO Solome Tibebu for health plans, employers, providers, and tech companies
Specific panels addressed SUD treatment access, State and MCO collaboration in Medicaid SUD care, the role of payers in SUD, and the role of lived experience in engaging hard-to-reach members.
Nationally prominent panelists included former U.S. Representative Patrick Kennedy—founder of The Kennedy Forum and lead sponsor of the landmark federal mental health parity legislation that became law in 2008—and Tom McLellan—founder of the non-profit Treatment Research Institute.
SUD from the payer perspective
Inspire Recovery included an all-payer panel—"The Health Plan's Central Role In Driving Innovation"—with executives from CareSource, Elevance Health (formerly Anthem), Magellan Health, and Optum participating.
The payer panel themes included:
- Digital health and how individual tools must fit with broader investment strategies
- Evidence-based treatment and outcomes measurement in SUD
- Total cost of care and ROI
- Provider support that includes both education and gatekeeping when necessary
"We're always looking for innovation that supports the evidence and what we can cover"—a good summation of topics from panelist Debra Nussbaum, senior director of Behavioral Health at Optum.
Closely linked to evidence-based treatment is outcomes measurement, nearly non-existent in the SUD field, but with payers having a growing role to play.
"There is a health-plan centric role in measurement: pay for what works and what consumers demand and expect." This from Eric Bailly, Business Solutions director at Elevance Health, who also noted that "we [payers] can't move fast enough" and that all stakeholders need to "let the science speak."
Another SUD mantra? "Let the data speak." So noted Dr. Caroline Carney, president and CMO of Magellan Health, who stressed where the ROI needs to be: in the outcome for the individual and the cost of care for the payer.
Nussbaum added the importance of standardization when it comes to SUD outcomes measurement.
"People think of SUD as the Wild Wild West."
Everyone in the field wants to change that perception—and bring alignment in two other key areas. The first is providers.
Carney added: "We need to support providers who are not on board yet … to define what evidence based is. Behavioral health includes lots of different kinds of providers and we need to hold all of them to the same standard"—possibly through a team-based approach to metrics.
"Providers may say they are following evidence-based treatment, but payers need to make sure they are sticking with the model, maintaining fidelity" said Jessica Johnson, director of Behavioral Health and Wellness at CareSource. "To make something evidence-based, you need data and you need time and pilot opportunities."
The second area needing standardization is digital health investment.
For Nussbaum, this translates to cautious optimism about telehealth. Quoting "Jurassic Park", she asked: "We can do it, but should we?"—noting the importance of environmental cues in in-person SUD treatment settings. "How do we do virtual care safely in the SUD space, keeping the member safe and not moving too fast?"
Bailly echoed the sentiment: "There's some level of the pendulum swinging back that we need to be prepared for … Telehealth in the digital health space is so much more than a forklift"—in other words, not simply a unidimensional alternative to in-person care.
Carney broadened the view.
"I love this space because the control tower that the health plan often is is important."
Being a control tower requires tech investment discipline.
Johnson recommends digital health paired with predictive analytics and multiple external data sources that wraparound to forma a digital approach that works.
"If a technology isn't tied to the rest of what you do, it's almost dead on arrival for consideration. You can't have parallel processes in the realm of SUD-mental health treatment," she said, adding: "How are you going to use the tool you're paying for? There must be a high level of discernment on the data."
During the panel's Q&A, Colleen Nicewicz, CEO of event co-sponsor groups Recover Together, capped off the discussion.
"You have to be able to hear the signal through the noise because there are only so many bets you can make."
Carter Paine, CEO of co-sponsor Wayspring, ended the conference with this: "Stigma is still very pervasive, but I think it's lifting a little. A lot of people were in this area [SUD] before it was cool. We all should feel really good about what we do, getting payers and providers together in coming up with new approaches to treat and manage SUD. I think our society has become much more supportive of this good work."
“Providers may say they are following evidence-based treatment, but payers need to make sure they are sticking with the model, maintaining fidelity. To make something evidence-based, you need data and you need time and pilot opportunities.”
Jessica Johnson, director of Behavioral Health and Wellness, CareSource
Laura Beerman is a contributing writer for HealthLeaders.
Last week's Inspire Recovery conference hosted payers, providers, startups, and venture capital.
All agree that an overall plan is lacking for substance use disorder (SUD) and that evidence-based treatment and outcomes measurement must become standard.
Four conference sessions covered access, collaboration, engaging hard-to-reach members, and the role of payers in SUD—with many stakeholders signaling that health plan leadership is welcome and needed.