Healthcare has a lot about value-based care (VBC) and how it can control skyrocketing costs while improving patient outcomes.In fact, the transition to VBC has produced Positive Outcomes in Primary Care and have Emerging alternative payment models in specialty care for other chronic diseases. So naturally, VBC has knocked on the door of behavioral health. The question is: Are behavioral health providers ready to open up? And what awaits them on the other side?
In a way, VBC has taken a long time to achieve behavioral health because—for better or worse—it is different from other health care. The “outsider” status of behavioral health providers is rooted in the historical fragmentation of the healthcare system, separating the mind from the rest of the body. This split has been perpetuated by the divestiture of health insurance, Poor enforcement of mental health equalityand low reimbursement rate. Behavioral health is further “alienated” due to the incredible stigma surrounding behavioral health conditions, major barriers to entryand female-dominated Profession.
Traditionally, behavioral health providers, especially those practicing outside the primary health system, have been excluded from the technological and financial innovations that shape most other parts of the modern American healthcare system.Most importantly, behavioral health providers, including social workers, community mental health centers, and providers not affiliated with the primary health system, are excluded from economic and clinical health care enacted as part of the American Recovery and Reinvestment Act. Information Technology (HITECH) Act 2009, therefore lack of resources And support the implementation of electronic health records (EHR).The use of paper records or other incompatible EHR systems remains common practice in independent and small practices health information exchange (HIE) and cannot “talk” to other providers in the health system or payer. also, Electronic Medical Record Adoption Integration with HIE still lags behind acute psychiatry and Substance Use Treatment Facility.
Most Americans have lived through a global pandemic to experience and understand the social and economic costs of behavioral health conditions.Costs associated with mental health or substance use disorders are often hidden in Co-occurring medical conditions, such as diabetes or chronic obstructive pulmonary disease. commercial insurance company There has been a focus on developing value-based care payment models and primary care-focused accountable care organizations, while other professional conditions, especially behavioral health, have been on the verge of developing alternative payment models. This is both because behavioral health care (and cost) is more challenging for providers to “belong with,” and behavioral health costs and outcomes are more difficult to integrate with other health care. Who is ultimately responsible for patients with multiple intersecting health conditions? Who gets “credit” and shares the savings when a patient gets better? In any case, how do we measure improvements in behavioral health? All good questions have no straight answers, which partly explains the lag in behavioral health value-based care.
When commercial insurers, and even Medicaid managed care organizations, try to develop value-based care models for behavioral health, they encounter several major challenges. In the absence of clear clinical measures of readily available “improvements” in A1c or blood pressure in the field, it is difficult to agree on what or how to measure behavioral health “outcomes.” But even if payers can develop a framework for assigning patients to behavioral health providers, teasing out associated costs, and defining meaningful and measurable outcomes—they still have to engage behavioral health providers and be prepared to engage and Success in terms of value – based on care.
Health plans have traditionally had weak, if not adversarial, relationships with behavioral health providers due to decades of fragmentation, inequality, and divestiture from other managed care organizations. Many behavioral health providers, especially psychiatrists, still practiced in cash-only systems outside of insurance due to low reimbursement rates and administrative burden. For those in the network, behavioral health providers often see insurance companies as “enemies” with whom they must negotiate higher rates or wrestle with service authorization.Payers often distance themselves from behavioral health providers and their professional organizations, viewing them as paraprofessionals at best, and exploitation or fraud The worst situation. The result of these misunderstandings is mutual mistrust and a chasm between suppliers and payers, which will take time and financial investment to close.
So if payers are ready to turn their attention to value-based care in behavioral health and invite behavioral health providers into the room — are providers ready to come in and fully participate in VBC? What do they need to be successful and how do they get there?
First, it starts from rebuild relationships and trust between payers and providers. On a very practical level, payers can rebuild trust by offering the proverbial olive branch — improving reimbursement rates and delivering on the promise of mental health equity (especially telehealth in a post-pandemic world). Deepening relationships starts with transparent communication between payers and providers. When I was in Blue Cross, North Carolina, we started the process by creating a behavioral health provider advisory board that included providers from diverse demographics, clinical specialties, and geographies. We are also actively reaching out to key suppliers and professional organisations to meet with them to understand their concerns and incorporate them into our strategic development plans.
2. Supplier needs educate Learn what values-based care means for behavioral health. Behavioral health providers want to be part of this conversation about value transfer, but many lack understanding or understanding of what payers actually mean when they say “value-based care.” They recalled bad past experiences with chart audits and administrative oversight.Providers need to hear “what’s in it for me” and acknowledge them Yes Doing strong clinical work and moving towards improved outcomes is an opportunity to demonstrate success. also, The payment model needs to be simple, and Measures and payments make sense Get suppliers to take on any projects that require extra effort, not to mention some form of financial risk. Performance-linked financial incentives must be significant enough to motivate behavior, but small enough to be realized in the short term. At the end of the day, behavioral health providers want to do what they can to help their patients improve, not get bogged down in extra work that doesn’t add value.
Finally, suppliers need Support, time and investment in tools and technology necessary to achieve these results. As I mentioned earlier, behavioral health providers lag behind other healthcare providers in adoption and sophistication of electronic health records.Likewise, measurement-based care and the use of tools such as patient-reported outcome measures (such as PHQ-9, GAD-7or PTSD checklist) is slowly growing in practice, but is still not widely or frequently used. Behavioral health providers can also leverage more advanced analytics to understand their patient populations, identify gaps in care, and flag actions they can take to prevent or follow up on care escalation points. Performance reporting dashboards can help providers get feedback on their own performance and make adjustments to their treatment plans or care delivery to improve outcomes. All of these tools and techniques can go a long way in helping behavioral health providers succeed in value-based care—but they all require financial resources and time to implement, and take longer to create sustainable change.
There is reason to hope that behavioral health providers are ready — and will be supported — to cross the threshold and move into value-based care payment models.early results of The impact of CCBHCs (Certified Community Behavioral Health Clinics) is promising, including increasing access to care and reducing emergency room and hospital utilization, among other outcomes.two types prospective payment system It is the value-based care model that CCBHC can use that will help behavioral health providers easily move into more advanced payment models and balance financial flexibility with clinical quality. While CCBHCs require significant federal funding to get off the ground and require ongoing technical assistance to support the program’s reporting requirements, there is a growing opportunity for more providers to become CCBHCs.President Biden recently State of the Union address and Commitment to Funding Mental Health Care It is the largest federal recognition of behavioral health support since President Kennedy first established community mental health centers in 1963. Additional federal investment, along with support from commercial payers and managed Medicaid organizations, will help behavioral health providers transition to EHRs and HIEs and become prepared for the type of data-driven care that will help them in value-based care Excellent performance in care arrangements. States can also continue to strengthen requirements for behavioral health value-based care in Medicaid purchases. If commercial payers follow suit, efficiencies will be gained when behavioral health providers deliver behavioral health care across their entire group.
The opportunities for these providers to enter value-based care now lie ahead of us, and their impact on health care costs, outcomes, and equity presents enormous opportunities. Payers should provide the support and investment needed, and providers should voluntarily enter value-based care or risk closing their doors.
Photo: Nuthaut Somsuk, Getty Images
