“Research suggests that sustainable SUD recovery is driven by multiple levers working together. The challenge for health plans is identifying how to measure their impact effectively.”
Liz Jones – SVP, Member Operations
For decades, success in substance use disorder (SUD) treatment has often been defined by a single outcome: abstinence. While reducing or eliminating substance use remains an important goal, it does not fully capture the complexity of recovery or the factors that help individuals achieve long-term stability and chronic condition management.
For health plans, a broader and more holistic framework is needed. Members with SUD frequently face co-occurring behavioral and physical health conditions, social challenges and fragmented treatment journeys. As a result, evaluating treatment success requires more than measuring substance use alone. It requires understanding whether members are improving in their overall well-being, mental health, functioning and ability to stay engaged in care.
Research and emerging care models suggest that sustainable recovery is driven by multiple levers working together. The challenge for health plans is identifying which levers matter most and how to measure their impact effectively.
Recovery is multidimensional
We recognize that SUD is a chronic condition that requires ongoing management rather than a one-time intervention. Treatment frameworks should emphasize evidence-based practices, chronic disease management, individualized treatment planning, medications for substance use, and social supports that address relapse prevention, harm reduction and long-term recovery.
Because recovery is rarely linear, outcome measurement must reflect more than substance use patterns. Members may experience meaningful improvements in depression, anxiety, daily functioning, relationships and quality of life before achieving full remission from substance use. These improvements often signal that treatment is working and that individuals are building the foundation for long-term recovery.
Here is where measurement-informed care (MIC) becomes valuable. Standardized assessments help clinicians monitor progress, identify emerging needs and adjust care plans as recovery evolves. Standardized measures like Lucet’s clinically validated Behavioral Health Index (BHI®) support this approach by measuring overall well-being, mental health symptoms and functioning in a single composite score. Internal validation work has demonstrated that the BHI is a reliable and valid outcome measure for adults struggling with substance use disorder, creating a more complete view of recovery than abstinence alone.
Members who need SUD treatment are often the most complex
Data continues to show that members with SUD represent some of the most clinically complex populations managed by health plans.
Many have multiple behavioral and physical health comorbidities, including depression, bipolar disorder, anxiety disorders and chronic medical conditions. The burden is particularly significant among members with alcohol use disorder (AUD), where co-occurring conditions often complicate treatment and recovery efforts. SUD populations also experience high rates of hospitalizations, emergency department utilization and movement across multiple levels of care. All of this underscores the importance of examining treatment patterns, transitions of care, follow-up visits, long-term outpatient retention, medication adherence and other indicators of ongoing engagement within a larger outcomes framework.
These members are often interacting with a wide range of providers, specialists and facilities across the continuum of care. In many cases, successful recovery depends as much on care coordination and continuity as it does on the treatment itself.
For health plans, this complexity highlights the limitations of single-point interventions. Effective SUD strategies must address the full member journey to recovery.
Access and engagement are critical levers
Two of the most important predictors of recovery are how quickly members connect to care and their sustained engagement after treatment begins.
For those ready for treatment, rapid access into care is one of the most critical levers for success. Likewise, for those requiring higher levels of care, timely follow-up after discharge, access to outpatient services and connection to community-based support systems are consistently associated with better outcomes. SUD providers and treatment programs should emphasize rapid connection to care, transition planning, coordination between facility and outpatient providers and support for community-based recovery resources.
Medication for substance use also play a critical role. It’s important for SUD programs to actively evaluate medication for substance use education, initiation and continuation for members with opioid use disorder and alcohol use disorder, while working with providers to reduce barriers to adoption. Stigma remains an outsized barrier, despite research consistently demonstrating the efficacy of intervention.
Technology-enabled navigation solutions, including Lucet’s NavConnect™, can further strengthen these efforts by helping members identify appropriate providers, schedule appointments more quickly and connect with resources that address transportation, housing and other social determinants of health. Timely access remains one of the most powerful tools available to prevent disengagement and reduce the likelihood of readmission.
Building a stronger definition of success
The complexity of SUD demands a multifaceted approach to treatment and outcomes evaluation.
Health plans should consider a broader set of success measures that include overall well-being, mental health symptoms, functional improvement, treatment engagement and continuity of care. They should also evaluate the quality of providers and facilities, support evidence-based practices such as medications for substance use and strengthen transitions from higher levels of care into community-based recovery programs. Provider quality measures, follow-up care, treatment retention, community resource referrals and member engagement all represent important levers within a comprehensive SUD strategy.
Ultimately, recovery is not defined by a single metric. It is shaped by the cumulative impact of coordinated interventions that help members improve their health, remain engaged in treatment and build lasting stability. For health plans, the future of SUD care lies not in measuring one outcome, but in understanding how multiple levers work together to support recovery.
Liz Jones is senior vice president of member operations at Lucet.
