Design and impact of bundled payment for detox and follow-up care

•An episode-based payment for detox could improve treatment engagement after detox.•Mean 90-day detox episode cost was $3743, mean risk adjusted payment was $3502.•Nearly 70% of the total mean cost consists of detox, inpatient, residential.•Some providers gain, but many lose revenue if payment based on low historic costs.•Future research should consider different designs and models for MAT engagement.