April 12, 2023
If you’re considering how to scale your behavioral health business to reach more patients, you likely know that Medicaid is the single largest funder of behavioral health in the U.S. In fact, no payer in the U.S. funds more behavioral health services than Medicaid. Accounting for 25 percent of spending on behavioral health, Medicaid covers 23% of nonelderly adults with mental illness, 26% of nonelderly adults with serious mental illness, and 22% of nonelderly adults with SUD. What you might not know is that your technology stack can be key to unlocking a more beneficial partnership with Medicaid.
As a joint federal and state health program, Medicaid is managed by the Centers for Medicare and Medicaid Services (CMS), a federal agency. In 2022, CMS issued its Behavioral Health Strategy, outlining how it intends for Medicaid and its other programs to: improve equity and quality in behavioral health care; increase access to SUD programs, improve pain treatment and management care; expand access and quality to mental health services; and leverage data to optimize services and outcomes. Digital technologies all play a crucial role in helping federal and state agencies deliver on these ambitious goals and scale programs effectively.
Let’s take a look at what you should know about how your technology investments, including electronic health record (EHR) systems, telehealth, and online patient portals, can help you build a more productive and profitable partnership with Medicaid.
During the pandemic’s public health emergency (PHE), Medicaid temporarily waived restrictions on reimbursement for telehealth services, enabling behavioral health organizations to continue delivering care to patients remotely. Telehealth has expanded significantly beyond audio-only and video-based therapy sessions, enabling providers to deliver both synchronous care, defined as live audio-only or video-based interaction between a provider and a patient, and asynchronous care, defined as information shared between a patient, provider, or caregiver that takes place during different points in time such as messaging.
Seventy-five percent of states report that behavioral health services were among those with the highest utilization of telehealth. This expansion also helped alleviate labor shortages; in fact, the state of Nebraska noted that telehealth was the most effective strategy for addressing its behavioral health workforce challenges, especially in underserved areas.
As the PHE winds down, permanent changes to pandemic-related telehealth expansions for behavioral health are being evaluated at the federal level; at the same time, many states are permanently adopting some or all of the expansions. Most experts expect some level of continued funding for telehealth. Behavioral health organizations should evaluate their telehealth solution to ensure that it meets the requirements for the states in which they operate. Look for a telehealth and virtual care solution like Qualifacts’ OnCall that enables delivery of both synchronous and asynchronous services on a secure and compliant network. Make sure your telehealth solution integrates with your EHR platform so that you can streamline operations and increase efficiency. Consider adding an integrated online patient portal to make it easy for patients to engage with providers and support staff outside of scheduled therapy sessions to increase patient engagement and improve outcomes even further.
In recent years, Medicaid has increased investments in programs that integrate physical and behavioral health services to better address patients’ medical, behavioral health, and socioeconomic needs. To that end, Medicaid launched a demonstration program of Certified Community Behavioral Health Clinics (CCBHCs) in several states across the U.S; for states not enrolled in the demonstration program, Substance Abuse and Mental Health Services Administration (SAMHSA) makes grants available for CCBHC planning. Operating as nonprofit organizations or local government agencies, CCBHCs offer a wide range of mental health and SUD services; crucially, they also integrate with local primary care and hospital partners, criminal justice agencies, health advocates, and other entities to provide comprehensive care across the patient’s journey. Based on early successes, the CCBHC movement is gaining ground; today, about 430 CCBHCs operate in over 40 states, Washington, D.C., and Guam.
Behavioral health providers can participate either as CCBHC or as a designated collaborating organization (DCO) that partners with a CCBHC, and integration and automation are key enablers of the CCBHC model. If you are considering participating in a CCBHC model, you should start by making sure your EHR supports integration with Medicaid payers and with other partner organizations. By making it possible for everyone involved to access patient information and monitor treatment and progress over time to deliver the best care, technology integration such as Qualifacts’ OnCall makes it possible to build productive, collaborative relationships with insurers and other providers. Automating workflows can reduce the administrative overhead of working within the Medicaid system, making it easier to collect patient information, automatically bill for appointments, and process billing and payments. This is even more significant as SAMHSA awarded 15 new states with CCBHC planning grants, helping more organizations like yours access new funding that can further enable client accessibility and interoperability.
Medicaid is also shifting its focus from fee-for-service (FFS) models that reward volume to alternative payment models (APMs) such as value-based care (VBC) models that incentivize data-informed, person-centered care that is also cost-effective. Data-driven payment models require that providers implement and maintain an integrated technology infrastructure to collect, aggregate, manage, analyze and share reporting data on patient treatment and progress to clearly demonstrate outcomes.
Telehealth software for behavioral health can be a foundational component of VBC. With an integrated telehealth solution, providers can deliver and track performance of reimbursable services that address the whole patient throughout their care journey. Such services include the use of digital tools that extend what’s learned during therapy sessions beyond the clinic walls, care coordinators, intensive case management programs, connections to peer coaches in recovery programs, and much more. Telehealth software for behavioral health such as Qualifacts’ OnCall solution can help you set performance metrics and continuously optimize the adoption and effectiveness of your program with real-time analytics. By enabling integration with your EHR platform, the OnCall solution ensures analytics and reporting can be shared with insurers and other stakeholders to document evidence of value provided.
Whether it’s an EHR platform, virtual care solution, or client portal, Qualifacts gives you the tools you need to increase access, integrate care, and implement a data-driven approach to delivering behavioral health services that also serves the goals of Medicaid payers. Investing in the right technology for your behavioral health program can help you overcome the challenges of working within Medicaid and unlock new opportunities to grow your patient population, increase engagement, and improve care outcomes.