A Cost Model for a Low-Threshold Clinic Treating Opioid Use Disorder

Area of Science:

• Health Economics
• Substance Use Disorder Treatment
• Healthcare Management

Background:

• The US fee-for-service model inadequately reimburses clinics providing comprehensive opioid use disorder (OUD) treatments.
• This funding gap impedes clinic expansion and access, particularly for marginalized populations.
• Existing payment structures do not account for the diverse costs associated with varying patient needs and service utilization.

Purpose of the Study:

• To estimate the actual cost of delivering medication for opioid use disorder (MOUD) and associated support services.
• To analyze cost variations based on patient complexity and treatment intensity.
• To provide a foundation for developing equitable and sustainable alternative payment models for OUD care.

Main Methods:

• Applied time-driven activity-based costing (TDABC), a patient-level micro-costing approach.
• Collected cost data from an outpatient clinic offering MOUD and voluntary psychosocial/recovery support services.
• Classified patients into three archetypes: light touch (1-3 visits), standard (avg. 8 visits), and quad morbidity (>20 visits) based on clinical and social factors.

Main Results:

• Significant cost variations were identified across patient archetypes.
• Indexed costs (initial visit=100) were: light touch (352), standard (718), and quad morbidity (1701).
• Patient complexity (co-occurring conditions, housing status, social support) significantly drove cost differences.

Conclusions:

• The current reimbursement system requires reform to reflect the true costs of OUD treatment.
• Patient stratification into archetypes is crucial for understanding cost drivers and informing payment models.
• Developing new payment models based on these cost structures can support the establishment and sustainability of accessible, multidisciplinary MOUD clinics.