Behavioral Health and Value-Based Contracting

Value-based care is emerging as a solution to address rising healthcare costs, clinical inefficiency, duplication of services and increased access to care. With a fee-for-service model, providers are paid based on the number of services they deliver (therapy sessions rendered). Payment has little to do with positive clinical outcomes. In contrast, reimbursement or payment in a value-based contracting model is based on indicators of value, such as client health outcomes, efficiency and quality. Value based contracting is about better care, better health and better costs.
By 2018, The Centers for Medicare and Medicaid Services (CMS) plans to transition 50 percent of all reimbursements to value-based models. Although healthcare experts agree that the prevailing fee-for-service model must change, there is no broad framework or agreement as to how the system can make a seamless transition. For behavioral healthcare providers, this transition is more complicated. Even though there is no health without mental health, mental health is still seen as distinct from physical health. The lack of quality measures and standards for behavioral health treatment poses some additional challenges.

Ultimately, our ability to reduce costs and improve quality depends on our ability to change our incentive structures … ‘the more-you-do, the more-you-get paid’ does not make logical sense … But now we are working hard to align payments to reward the right care to every patient, each and every time.” Kathleen Sebelius, Secretary of HHS (2014)

Did you know?
• In 2011, more than 41 million U.S. adults (18 percent) had any mental illness, and nearly 20 million (8 percent) had a substance use disorder.
• In 2002, 49% of all Medicaid beneficiaries with disabilities in the United States had a psychiatric diagnosis and these individuals were in three of the top five most expensive co-morbidity groups.
• Behavioral health disorders were one of the five most costly conditions in the United States in 2006, with expenditures at $57.5 billion.

The transition from a fee-for-service model to a value-based contracting model is one that could take several years. Behavioral healthcare providers will need advanced analytics to measure financial and quality targets for different services rendered and different populations served. Furthermore, these quality standards need to be met sooner rather than later. Providers need to be asking questions like which programs are demonstrating the best performance, which clinicians are achieving the best outcomes and how can these be replicated across different sectors of an organization.

A great resource and tool to track the delivery of effective, efficient and accountable outcomes is REBOOT™. REBOOT (Reliable Evidence-Based Outcomes Optimization Technologies) is a platform that provides real-time mobile access to client interactions, progress towards goals and much more. This platform can be utilized with individuals, environments, policies, practices and procedures, resources, monitoring systems, etc. and the target for improvement could be an individual’s goal, program’s goals or an organization’s goals.
To learn more about REBOOT℠, please visit ProEventa, Inc. is a consultative software company and a subsidiary of Grafton Integrated Health Network.

What can Behavioral Healthcare providers do to succeed in the midst of this transition?
• Define activity-based costs—Providers must examine and evaluate activity based costs which includes not only the amount of time to deliver the service and who’s delivering it, but looking at overhead and indirect costs as well.
• Track quality measures and achieve good clinical outcomes—Payers will need to see evidence of consistent good outcomes and predictable costs associated with those outcomes.
• Explore variation in cost and quality—It is important to assess financial and clinical data to not only improve quality of care, but also to reduce variation in cost and quality and strengthen the bottom line.
Although there are no easy answers, behavioral healthcare providers should at least begin the conversation, analyze their own operations and develop new ways to market their value now. The ones who do so are best positioned to succeed.