Every single hospital and health system provides benefits to their communities that far outstrip any other sector in health care. What commercial health plan or drug or medical device company ever responded to a heart attack, car accident, or child’s midnight fever with open doors and compassionate care? But that is what hospitals do every day. Some hospitals are exempt from federal and some state and local taxes. For that privilege, they dutifully publicly report the range of benefits and services they provide to their communities, one of which is financial assistance for those in need. The reports hospitals file every year with the IRS both counts and describes these benefits.

The transition to value-based care (VBC) in the substance use disorder (SUD) industry is a good sign, but the shift may be challenging for some providers. The good news is that it is attainable for most providers if they can deliver value across the 4P’s of healthcare: patients, people, payers and partners. To better understand this—and the barriers to accomplishing it—it’s helpful to look at how the industry has evolved and the three distinct market shifts over the last two decades.