Outcomes As An Addictions Differentiator

The new data is out—showing about 87,000 drug overdose deaths in the U.S. from October 2023 to September 2024, down 24% from around 114,000 the previous year. This is the fewest overdose deaths in any 12-month period since June 2020. 

But, drug overdoses remain the leading cause of death for Americans aged 18 to 44. And the public health situation varies by geography. Five states—Alaska, Montana, Nevada, South Dakota, and Utah—saw increases in overdose deaths.

Despite the progress in reducing overdose deaths, the relapse rate for substance use disorders is 40% to 60%. And only about 10% of those with an addiction actually get some sort of treatment.

Headquartered in Center City, Minnesota, Hazelden Betty Ford is a $219.7 million non-profit that provides prevention, treatment, and recovery support services for adults, youth, and families affected by alcohol and other drug addictions. It has 15 locations across eight states, employs approximately 2,000 staff, and serves over 25,000 consumers annually.

The Hazelden organization tracks a wide range of clinical performance data. Primary performance metrics include time to treatment initiation, treatment engagement, and follow-up after high-intensity addiction treatment. Their team also measures the HEDIS (Healthcare Effectiveness Data and Information Set) subset of substance abuse measures—like follow-up after emergency department visits and use of medications for opioid use disorder.

Hazelden’s team has used its outcomes data to demonstrate effectiveness and negotiate with payers for improved reimbursement models, such as value-based contracts with shared savings or annual bonuses. In one health plan partnership, Hazelden had an 84.2% follow-up rate compared to the benchmark of 66.7%—performance that is highly-valued by health plan executives.

And tracking performance is also useful in improving clinical programming. But Ms. Duncan-Sanford noted that a data-driven approach requires significant culture change, staff retraining, and transparency to improve. By helping staff understand the “why” behind data collection and payer collaboration, they successfully transitioned toward a performance-focused model of care. “The metrics can lead to improvements in care and treatment. Twice as many of our patients report continuous sobriety for the year following treatment as rates cited in addiction treatment research.”

Based in South Padre Island, Texas, T&R Recovery Group is a for-profit behavioral health organization established in 2022. The organization operates multiple facilities, including Sabino Recovery in Tucson, Cypress Lakes Recovery in Texas, and Origins Behavioral Health in South Padre Island and Dallas. T&R focuses on trauma-informed, evidence-based care and offers both in-network and high-end services across the full continuum of treatment.

From the beginning, T&R Recovery Group embedded outcomes measurement into its strategy. Rather than developing their own internal system, they partnered with a third-party, Vista Research Group, to collect outcome data. They collect measures like treatment completion rates, abstinence at one year post-treatment, weekly assessments of depression, anxiety, suicidality, cravings, and patient satisfaction. They also analyze reductions in ER visits, hospitalizations, and detox episodes to demonstrate cost savings and treatment impact.

T&R uses this real-time data to improve clinical care and support business operations. Weekly “patient report cards” track progress and inform treatment plans, while aggregated data helps clinicians and leadership identify at-risk patients, against medical advice (AMA) discharges, and support team-wide performance improvement. Staff can also compare clinician-specific data, such as completion rates and patient improvement trajectories, to guide training and resource allocation.

In addition, T&R uses outcomes data to build trust with families and potential clients—and for staff motivation. Outcome data for each program is available on their web site. And clinicians receive patient feedback and outcomes—experiencing a sense of accomplishment.

Both executives spoke to the importance of outcome measures in building relationships—both with consumers and with payers. For consumers, outcome data can increase referrals and improve the retention of existing consumers. 

Outcome data is also used with payers to increase referrals, gain preferred network status, and negotiate higher reimbursement rates. Mr Goodstat said, “For example, Cypress Lakes Recovery had an 81% treatment completion rate, which is significantly higher than the 65% average across Vista’s 68,000-patient benchmark. T&R presents these results to payers to justify higher reimbursement rates and demonstrate value, particularly in regional and exchange-based markets. “Patients had fewer ER visits, hospitalizations, and detox treatments post-treatment, resulting in an average $23,000 annual savings per patient. Multiplied across just 123 patients, that translates into $2.8 million in savings for the payer.”

The case studies demonstrated how organizations with better data are positioned to improve performance and customer relationships. As Ms. Duncan-Sanford noted, “With the right care, support, and time, recovery from substance use disorders is not just the norm. Our patient outcomes data show that recovery becomes the catalyst for an all-around better quality of life.”