FORE Grant Targets Payment Reform to Boost Opioid Treatment Access

NEW YORK, NY – April 08, 2026 – In a strategic move to address a critical flaw in America’s fight against the opioid crisis, the Foundation for Opioid Response Efforts (FORE) has awarded a $473,675 grant to The Brookings Institution. The two-year project aims to dismantle the financial and insurance-related barriers that prevent millions of Americans with opioid use disorder (OUD) from receiving life-saving care.

The initiative, led by renowned health economist Dr. Richard Frank, will develop new payment models designed to incentivize high-quality, evidence-based treatment. This comes as data reveals a staggering treatment gap: despite the availability of effective Medications for Opioid Use Disorder (MOUD), an estimated 83% of individuals who could benefit from them do not receive them. The project seeks to fundamentally rewire how care is paid for, shifting the focus from volume of services to the value of patient outcomes.

“Despite progress in expanding access to treatment, financial incentives within current payment systems often fall short of supporting the full continuum of evidence-based care,” said Karen A. Scott, President of FORE, in the announcement. “This project aims to identify practical, scalable payment models that increase treatment engagement and retention, improve outcomes, and reduce overdose deaths.”

The Systemic Failure in OUD Treatment Funding

The grant addresses a deep-seated paradox in the U.S. healthcare system: while effective treatments for OUD exist, the prevailing payment structures often make it difficult for providers to offer them comprehensively. The current system is dominated by a fee-for-service model that reimburses individual procedures and visits but frequently fails to cover the full spectrum of care necessary for long-term recovery.

This creates a system where critical, non-billable services—such as care coordination, peer support, and patient navigation—are often unfunded, forcing providers to either absorb the costs or omit these essential components. The result is fragmented care that falls short of national quality standards. For the millions covered by public insurance, the problem is particularly acute. Medicaid, the single largest payer for OUD treatment in the nation, covers an estimated 40% of adults with the condition. Yet, recent studies show that nearly 70% of newly diagnosed Medicaid enrollees do not receive timely access to MOUD within six months.

Similarly, fewer than 40% of Medicare beneficiaries with OUD received care that met national quality standards in 2020. Low reimbursement rates disincentivize providers from accepting public insurance, creating provider shortages and “treatment deserts,” especially in rural counties. Administrative hurdles like prior authorization requirements further delay access to medication, a critical window when patients are most vulnerable.

A New Blueprint for Value-Based Addiction Care

The Brookings project represents a concerted effort to design a better system. By focusing on value-based care, the initiative seeks to align financial incentives with what is clinically proven to work. Instead of paying solely for visits and prescriptions, the new models would reward providers for achieving positive patient outcomes, such as treatment retention and long-term recovery.

Led by Dr. Frank, Director of the Center on Health Policy at Brookings and a former top official at the U.S. Department of Health and Human Services, the project will leverage deep expertise in health economics and public policy. The team will pursue a multi-pronged strategy:

• Developing Performance Metrics: The first step is to define and measure quality. The project will create evidence-based metrics to assess performance across the entire continuum of OUD care, from initial patient engagement to long-term recovery support.

• Designing Payment Models: Using these metrics, the team will design new payment structures, such as bundled payments that cover an entire episode of care, or pay-for-performance models that reward providers for meeting specific quality targets. These models will be designed to support comprehensive treatment, including vital wraparound services.

• Creating a Simulation Tool: To aid policymakers, the project will develop a simulation tool to help state and federal agencies assess the trade-offs of various design options, allowing them to tailor models to their specific populations and budgets.

• Providing Technical Assistance: Recognizing that implementation is as crucial as design, the initiative will provide direct technical assistance to state Medicaid agencies to help them adopt and adapt these new models.

This approach mirrors successful payment reform efforts in other areas of healthcare, such as accountable care organizations (ACOs) and bundled payments for surgeries, which have shown potential to improve coordination and reduce costs.

From Policy to Patients: The Human Impact of Payment Reform

While the project is rooted in the complex world of health economics, its ultimate goal is profoundly human: to save lives. For individuals struggling with OUD, the proposed changes could mean the difference between a cycle of addiction and a path to recovery. A system that pays for value would encourage providers to offer integrated care that treats the whole person, not just the addiction.

This means a patient might not only receive a prescription for buprenorphine but also get connected with a counselor, a peer recovery coach, and a case manager who can help with housing or employment. It means a primary care doctor would have the financial support to screen for OUD and initiate treatment directly in their office, reducing stigma and increasing access. The focus on community-based care is designed to meet patients where they are, strengthening the support networks essential for lasting recovery.

With overdose deaths remaining at historically high levels—claiming over 50,000 Medicare beneficiaries alone in 2021 through fatal or nonfatal events—the urgency for such a transformation is undeniable. By ensuring more people can access and remain in effective treatment, these new payment models have the potential to significantly bend the curve on the nation's overdose crisis.

Navigating the Hurdles of Healthcare Transformation

The path to reforming healthcare payment is rarely straightforward. Similar initiatives in other fields have faced challenges, including provider resistance to financial risk, the high cost of data infrastructure, and the administrative burden of new reporting requirements. The addiction treatment field also faces a unique challenge in the lack of industry-wide consensus on the best metrics to measure the value of care.

The Brookings project appears designed with these hurdles in mind. By creating a simulation tool and offering technical assistance, it aims to lower the barrier for state agencies to adopt new models. By focusing on developing clear, evidence-based performance metrics, it seeks to build the consensus needed for widespread adoption.

The findings from this two-year grant will be shared broadly with policymakers, health systems, and payers through a series of policy briefs and reports. The goal is not just to create a theoretical model, but to provide a practical, evidence-based roadmap for states and the federal government to follow.

“By aligning payment with what works, we can help ensure more people receive effective treatment and stay engaged in care,” Dr. Frank stated. “Ultimately, this work is about improving outcomes and saving lives.”