Building Payer Partnerships That Deliver: A Practical SUD Playbook

Later this April, I’ll be joining a panel at NATCON 2026 titled “Building Payer Partnerships That Deliver: A Practical SUD Playbook.” This session brings together perspectives from across the ecosystem—payer, provider, policy, and data—to focus on one of the most important (and often misunderstood) areas in behavioral health today: how to design value-based reimbursement models that actually work.

The conversation around value-based care in behavioral health—particularly substance use disorder (SUD) treatment—has evolved significantly over the past decade. Yet despite the momentum, many organizations still find themselves asking the same questions:

• What does “value” actually mean in SUD care?

• What are payers really looking for?

• How do we operationalize outcomes in a way that is credible, scalable, and financially sustainable?

This panel is designed to move beyond theory and into practical application, and will include input from the following panelists:

Eric Bailly Founder, NorthStar Behavioral Health Advisory

Kathryn Cohen, Senior Director of Regulatory Affairs at ABHW

Sam Nordberg, Chief of Behavioral Health at Reliant Medical Group

Eric Gremminger, Co-Founder and CEO at ERPHealth

Why This Conversation Matters Now

Behavioral health organizations are operating in an increasingly complex environment. Reimbursement pressures, shifting payer expectations, workforce constraints, and the need to demonstrate measurable outcomes are all converging at once.

At the same time, payers are becoming more sophisticated in how they evaluate provider performance. We’re seeing a growing emphasis on:

• Outcomes-based contracting

• Network tiering and preferred provider strategies

• Centers of Excellence models

• Total cost of care considerations

For SUD providers in particular, this represents both a challenge and an opportunity.

The challenge: translating clinical impact into data that resonates with payers.

The opportunity: positioning high-quality programs as indispensable partners in managing cost, improving outcomes, and expanding access to care.

What This Panel Will Explore

This session brings together a unique mix of perspectives:

• Provider leadership grounded in clinical and operational realities

• Payer insight into how decisions are actually made

• Policy expertise shaping the broader regulatory landscape

• Data innovation enabling more sophisticated measurement and validation

Together, we’ll unpack what it truly takes to move from volume to value in SUD care.

Questions We’ll Be Considering

As with my previous panel discussions, I find that the most valuable conversations are anchored in the right questions. Here are a few we’ll be exploring together:

Defining Success in Value-Based Care

• From your vantage point, what are the key components of successful value-based reimbursement arrangements between payers and providers?

• What does “success” actually look like—clinically, operationally, and financially?

Learning from What’s Working

• Where have we seen value-based models succeed in behavioral health or SUD care?

• What outcomes were achieved, and how scalable are those models across different markets?

Barriers and Roadblocks

• What has slowed adoption of value-based methodologies?

• Where do misalignments between payers and providers still exist?

The Future of Value-Based Reimbursement

• Looking ahead 3–5 years, how will these models evolve?

• What capabilities will organizations need to remain competitive?

The Payer Perspective: What Really Matters

• How are outcomes data being used today to shape provider networks (e.g., tiering, preferred partners, Centers of Excellence)?

• What level of patient engagement or completion is necessary for outcomes data to be considered credible?

• Why does third-party validated data matter—and where do provider-reported metrics fall short?

Proving Value and ROI

• What evidence do payers need to see to believe in the ROI of a clinical program?

• How do case-rate arrangements work in practice, and how can providers negotiate them effectively?

• If a program keeps patients out of higher-cost settings, how is that value quantified?

• How can data collection be embedded into the clinical model rather than treated as an afterthought?

A Practical Playbook, Not Just a Philosophy

One of the things I’m most looking forward to in this session is grounding the conversation in practicality.

Value-based care cannot be an abstract concept. It must be:

• Operationalized within clinical workflows

• Supported by reliable and defensible data

• Aligned with payer priorities

• Structured in a way that is financially viable for providers

Too often, organizations approach value-based care as an add-on. In reality, it requires a fundamental shift in how services are designed, delivered, and measured.

How NorthStar Behavioral Health Advisory Can Help

At NorthStar Behavioral Health Advisory, this is exactly where we focus.

We work with organizations at the intersection of clinical care, payer strategy, and data-driven decision making to:

• Design and negotiate value-based reimbursement arrangements across commercial, Medicare Advantage, and Medicaid managed care

• Translate clinical programming into payer-relevant outcomes and ROI narratives

• Build data strategies that support contract performance, network positioning, and reimbursement integrity

• Align operational workflows with sustainable, scalable payment models

• Support organizations in navigating the transition from fee-for-service to value-based care

Whether you’re just beginning to explore value-based models or looking to refine existing arrangements, the goal is the same: to ensure that high-quality behavioral health care is recognized, rewarded, and sustained.

Final Thoughts

Value-based care in behavioral health isn’t coming—it’s already here. The organizations that succeed will be those that can clearly articulate their value, measure it effectively, and align with payer expectations without losing sight of the people they serve.

If you’re attending NATCON this year, I hope you’ll join us for what promises to be a highly practical and engaging discussion.

You can learn more and register for 2026 NATCON, which is being held in Denver, CO between April 27 and April 29, by following this link: https://www.thenationalcouncil.org/natcon/