The Great American Recovery
Treat the biology.
Measure the recovery.
A root-cause, outcomes-accountable national model for Alcohol & Substance Use Disorder, built through the authority the Department already holds.
No new statute. A model already in operation, at scale, with validated outcomes, ready to move from a working program to a permanent standard of care.
The scale of the problem
Yet it is treated, financed, and measured unlike any other disease of comparable severity. The reason is not a shortage of spending, the dominant treatment methodologies simply do not work.
Sources: SAMHSA NSDUH 2023; NIDA and published treatment-outcome literature.
The dominant methodologies don't work.
Addiction is not a side issue to chronic disease. It is a primary driver of it. Legacy treatment fails most patients, drives expensive downstream disease, and stays largely invisible to the systems paying for it.
Even the best legacy treatment returns just 10-13% of patients to sustained recovery at one year.
Most claims systems identify ~1% of affected people against an actual prevalence near 17%. The spending is real, large, and largely invisible.
LOBAT
LOBAT is a year-long, home-based, genomic-guided, nutrient-restoring medical program.
There is now a model that treats the biology.
Pharmacogenomic sequencing
The right medications, the first time.
Targeted nutrient repletion
Restores the brain chemistry chronic use destroys.
One accountable care team
Physicians, NPs, nurses, therapists, navigators, and peers, 7 days a week.
Anonymous immersive groups
Voice-masked VR/AR dismantles the stigma barrier.
Continuous outcome monitoring
Verified week over week, digitally monitored, not self-attested.
A contractual Performance Guarantee
Any return to use is restabilized at no charge.
And one that proves the result.
This is the evidence-based addiction model the field has lacked for a generation, and it already exists, in production, at scale.
At twelve months, compared to the ~13% rate for residential rehab.
At twelve months, against the high dropout of the legacy model.
Gains across mood, anxiety, trauma, cognition, and resilience.
Among the highest in American health care. Patients value it.
Measured across the whole person.
NorthStar measured clinical outcomes (internal analyses). Comparison figures for traditional inpatient treatment are drawn from published outcomes research.
One model, two coordinated tiers.
Both year-long, medication-forward, outcomes-accountable, and home-delivered, differing in clinical intensity.
Light-Touch Model
Year-long, medication-forward telehealth care for single-substance use disorder without significant comorbidity.
- ✓Medication-forward care, multidisciplinary team, 7 days a week
- ✓Delivered in the home; anonymity-protected virtual groups
- ✓Validated outcomes panel: PHQ-9, GAD-7, K10, PCL-C
- ✓Three-domain outcome bonus, up to 15%
An adult who binge-drinks several times a week; work and family life beginning to suffer, but experiences no daily physical dependence.
Integrated Precision Model
The higher-intensity longitudinal model for patients whose complexity demands fully integrated care.
- ✓Mandatory: DNA-guided prescribing & nutrient repletion
- ✓Polysubstance, psychiatric & medical comorbidity management
- ✓24/7 care team; serial cognitive testing tracks recovery
- ✓Five-domain outcome bonus, up to 25%
An adult with alcohol and benzodiazepine dependence needing supervised detox, plus co-occurring depression, anxiety, and hypertension.
Five phases, two places of service.
A single longitudinal team follows the patient across both settings, escalating and de-escalating as clinical need requires.
Home Path
~95% OF PATIENTSTaper & medication induction at home, 24/7 remote monitoring.
Full psychiatric eval, DNA-guided prescribing, nutrient repletion, trauma care, VR/AR groups.
Behavioral change & resilience, continued optimization, increasing autonomy.
Chronic-condition management, co-occurring disease care, completes the program year.
Quarterly check-ins; any return to use restabilized at no charge ($0 code).
*When severity or home environment makes home care unsafe.
Intensive Integrated Continuity Setting (IICS) Path
~5% OF PATIENTSMonitored medical detox & supervised residence, only when severity or home environment makes home unsafe.
The same care, delivered in the inpatient setting when clinically required.
Supervised residence for the intensive-care phase where required.
The nation is already paying more, for care that does not work.
One untreated patient
Not one bill. An accumulating cost, with no guarantee at any point.
A guaranteed LOBAT year
A single all-in price for the year, base annual cost before outcome incentives.
per veteran for a single episode of community residential care (FY2023-24), at $2,766 per day, with $807M paid above the federal benchmark.
A full guaranteed LOBAT year costs a fraction of one failed episode.
A national path, all under existing authority.
No new statute. Three instruments the Administration already holds carry the model from a working program to permanence.
MAHA Evidence Initiative
Position LOBAT as the exemplar, a federally supported evaluation cohort with validated outcomes infrastructure already in production.
CMMI National Recovery Demonstration
Build & test value-based bundles with outcome incentives. 10,000 patients, propensity-matched, and powered for permanence.
Expansion to Permanence
On the evidence and the Chief Actuary's certification, the Secretary expands nationwide. Permanent Medicare & Medicaid code families follow.
First patients September 1, 2026. Permanent codes by month 24.
One arc: a 10,000-patient pilot with the VA and the Department of War, funded from week one; an ONDCP-chaired interagency task force running 18 to 24 months alongside it; and the permanent Medicare and Medicaid code families issued through CMMI at the end.
ONDCP convenes the coalition; pilot design and cohorts set with the VA and the Department of War; the payment structure adopted so funds flow at launch
The 10,000-patient pilot launches with the VA and the Department of War; the interagency task force begins its monthly cadence
Task-force workstreams and barrier removal per agency; CMMI code co-development begins; quarterly status and interim outcome reads
Mature retention and outcome data; the Qualifying LOBAT Provider certification pathway built out; CMMI code families near completion
Demonstration completes; certification pathway live; CMMI creates the permanent Medicare and Medicaid code families
A model already in operation. One demonstration from test to permanence.
Name LOBAT the model of the Great American Recovery
Position LOBAT as the exemplar: a federally supported evaluation cohort with validated outcomes infrastructure already in production.
Build the payment architecture through the CMS Innovation Center
Direct CMMI, under 42 U.S.C. § 1315a, to develop and test a longitudinal, value-based bundled-payment model for AUD and SUD, designed from the outset for expansion to permanent Medicare and Medicaid coverage.
Convene the principals
Bring the MAHA policy team, the CMS Innovation Center, and NorthStar into one room to align the evidence framework, the payment design, and the clinical model, and open one government population where care can begin now.
Take the framework with you.
The interagency implementation framework, the agency policy frameworks, and the at-a-glance overviews, ready to download and share.
