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What Clinical Directors Should Know About Value-based Care for Behavioral Health

What Clinical Directors Should Know About Value-based Care for Behavioral Health
What Clinical Directors Should Know About Value-based Care for Behavioral Health
What Clinical Directors Should Know About Value-based Care for Behavioral Health

October 14, 2022

What Clinical Directors Should Know About Value-based Care for Behavioral Health

Soaring medical costs and declining quality of care in the U.S. have led Medicare and insurers to look for alternative payment models such as value-based care (VBC), aiming to improve clinical outcomes for patients while reducing costs. VBC has demonstrated promising results, and models are being extended outside primary care to medical specialties. 

Recently, interest in adapting VBC to behavioral health has been increasing. With rapid adoption of telehealth for behavioral health during the pandemic, insurers and behavioral health companies see the potential of VBC to help address the myriad challenges the industry faces, from growing provider shortages to surges in demand. For behavioral health company leaders, VBC can open the doors to innovative service delivery and reimbursement models that can transform many of the challenges into opportunities to increase access and improve outcomes while reducing costs. 

What is value-based care?

Unlike a traditional fee-for-service model, in which providers are reimbursed for the quantity or units of service provided, a VBC model pays providers based on patient outcomes that have been pre-determined by a contract or a framework. The goal is to improve outcomes while lowering the cost of care using evidence-based practices. Examples of VBC programs include:

VBC approaches are proving effective in incentivizing providers to address the whole patient and their varying needs across a spectrum of care and time.They’re also proving successful in reducing the overall cost of care.

How is VBC being adapted to behavioral health care?

Even before the surge of mental health issues during the pandemic put increased demand on an already overburdened supply of behavioral health providers, forward-thinking behavioral health companies were starting to leverage value-based approaches to deliver services. These organizations are seeking to expand access to more patients, offset the labor shortage, and increase the tools available to providers to address the whole needs of their patients.

The recent rapid adoption of telehealth for behavioral health has greatly accelerated this movement. Prior to 2020, few insurers would reimburse for telehealth. But in response to the pandemic, and with changes to state and federal regulations to allow providers to bill for behavioral telehealth visits, telehealth use soared. UnitedHealthcare, for example, reported a 2,500% increase in virtual care visits, about half of which were for behavioral health issues. (Behavioral Health Business). 

Experts predict that demand for these services will remain even as the social distancing needs of the pandemic wane. Insurers are signaling a continued commitment to evolve reimbursement models to better support behavioral health providers. For example, the Centers for Medicare & Medicaid Services (CMS) is strengthening its behavioral health services benefits for Medicare recipients, adopting a, “data-informed approach that removes barriers to care and services and promotes person-centered behavioral health care.”

Major benefits of VBC for companies, providers, and patients

As VBC gains momentum, behavioral health companies should consider how potential these changes may impact their service delivery and business models. The Medicare Shared Savings Program, used by accountable care organizations, is designed to easily enable health systems and providers to work together to deliver coordinated care that improves clinical outcomes. This is to encourage companies to focus on caring for the whole individual and their myriad needs; rather than single challenges and health concerns. Incentivizing companies to focus on continuity of care is essential for patients who see multiple providers and require continuity of care to improve their outcomes. (helio.com)

Another benefit of VBC for providers is the potential for bonus payments if a patient’s therapeutic assessment scores rise. For example, Blue Cross North Carolina and Quartet Health partnered to improve behavioral healthcare access and outcomes, “incorporating health and cost outcomes” to tie together patient results and payment models. Providers with high patient assessment scores were given a bonus payment for their improvements.Companies seeking to decrease provider churn because of burnout can incentivize staff with these bonuses to reduce churn s. 

VBC also enables payers to change the payment structure of providers who are not meeting care standards. (helio.com) Companies that are delivering high quality care and substantially better patient outcomes “can negotiate for better reimbursement rates from payers.” (Behavioral Health Business) This allows payers to incorporate more VBC structures into their payment models with the data provided. This data is essential to understanding, developing, and leveraging VBC models, which payers rely on to create their payment structures for companies.

What behavioral health companies can do now to prepare for VBC

Here are some steps you can take now to learn more and pave the way. 

  • The pivot the VBC requires extensive changes to how services are delivered, paid for, and reimbursed. Behavioral health companies considering VBC should start with deep-dive exploratories to learn as much as they can from early adopters, and to understand the wide-ranging implications to their business models. Early-stage research and exploration should aim to answer questions such as:
  • What technology investments might be needed to implement and maintain the integrated infrastructure needed for a measurement-based care approach
  • How to define quality of care and patient experience and what metrics would support assertion of successful achievement of quality
  • How the existing service delivery model can be adapted to a VBC approach that addresses the complexity of the behavioral health care continuum and the variability of individual experiences within it
  • What provider reimbursement models are available, and how to align mental and behavioral health outcomes with them
  • How to navigate and adapt to continuously evolving policies and regulations

Start collecting patient-reported outcomes

You don’t have to implement a formal VBC program to start collecting standardized measurements that assess behavioral health outcomes. In fact, 66% of respondents in a recent Owl-MHBC survey indicate they currently collect patient-reported outcomes measures (PROMs) to support clinical decision making. And although 66% of those collecting PROMs are doing so through their electronic health record (EHR), 17% used paper or some other method of gathering data. (Behavioral Health Business) 

PROMs can be any report from patients about their status, without interpretation by a clinician or anyone else (National Quality Forum). For example, a PROM might be a simple patient status survey implemented before, during and after care.

Simply starting a more formal measurement program can illuminate opportunities for immediate optimization of existing programs, as well as educate your team about the process of collecting, analyzing, and reporting on quality data.

Invest in telehealth software for behavioral health

For some leading behavioral health companies, telehealth software for behavioral health is becoming a stepping stone technology on the way to enabling a VBC approach. While implementing VBC can require significant investment in technology not typically required for more traditional fee-for-service-based business models, telehealth software for behavioral health can provide the ability to 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 OnCall’s 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 electronic health records (EHR) system, the OnCall platform also ensures analytics and reporting can be shared with insurers and other stakeholders to document evidence of value provided.

Learn more about how OnCall helps behavioral health companies evolve and grow

Adopting a VBC approach in your behavioral health program can open the door to innovative new service delivery and business models that increase access and improve patient experience and outcomes while also reducing costs. By building on top of telehealth software for behavioral health such as the OnCall platform, behavioral health companies gain a simple, scalable way to get started.

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