As the healthcare field evolves into a more efficient system, key changes allow for advances that are revolutionizing the industry. An innovative new value-based care model has expanded the focus to reducing costs, decreasing medical errors, and achieving better overall health for clients. Providers are increasingly turning to this value-based healthcare model in order to achieve value-based results.
Under this model, providers are rewarded for helping individuals reduce the negative impact chronic disease can have on a client’s life and the number of occurrences of chronic diseases. Rather than being paid by each service they prescribe or perform, they are rewarded based on the health of the client.
A value-based model can:
- Lower costs for clients
- Increase client satisfaction
- Offer reduced health risks
- Align prices with outcomes
- Lead to better overall health
This model is spreading through the primary care industry and while it’s had a positive impact, the behavioral health industry has been slower to adopt it.
The Marriage of Physical and Mental Health
According to the Center for Health Care Strategies, “Many state Medicaid programs have developed value-based payment (VBP) approaches to improve quality and low-cost growth for physical health services, but these advances have been slower to emerge in Medicaid behavioral health programs.”
We’ve often addressed the fact that physical and mental health need to be aligned in order to better achieve optimal overall health. It’s been shown that clients who have fewer instances of behavioral health issues are more likely to recover quickly and get treated for other physical ailments. On the other hand, a client suffering from depression may not seek out the treatment they need. Value-based models focus on outcomes rather than treatments, meaning that providers are rewarded when clients feel better.
Instituting value-based healthcare models in behavioral health means that data would be used to offer providers a holistic look at a client’s health. This data would be used to treat the client and to measure outcomes.
As it stands now, “spending for individuals with a behavioral health diagnosis is nearly four times higher than for those without.”
Value-Based Behavioral Health
What would it mean to adopt a value-based model in the behavioral health sector? It would require looking at the whole person physically and mentally, not just addressing a specific complaint or ailment.
When a client presents with a broken arm, a medical professional x-rays the arm, gauges the pain, and creates a treatment plan that focuses on the arm. When a client presents with complaints of anxiety, extreme fatigue, or signs of depression, the whole person must be examined to find out where the symptoms stem from. There are also instances where a client presenting with pain could be experiencing behavioral issues that are manifesting as pain. When medical professionals are unable to diagnose the root cause of the complaint, the client could go untreated.
Many practices now screen all patients for behavioral conditions, like depression or anxiety, before scheduling surgery. This practice marries behavioral and physical health and is one example of how these two disciplines can work together.
One doctor adopted this procedure and reduced the number of orthopedic procedures that his clinic performed by nearly 50% while increasing the number of patients treated using different modalities. Using these numbers to look at the future is a prime example of using value-based care in behavioral health.
Various models that behavioral healthcare providers can adopt were presented by Evolent Health in 2013:
Pay for Performance: which ties financial incentives to measured performance
Patient-Centered Medical Home: which establishes a team of health professionals that work together to coordinate a patient’s care, particularly those with chronic or complicated conditions
Shared Risk: under which the provider must cover part of the costs if they do not meet savings targets
Clients with fewer instances of behavioral health issues tend to face fewer doctor’s visits, medical tests, and procedures. They also spend less money on medication. When long term health is improved, people have better management of their chronic diseases, and are able to limit costly hospitalizations or emergencies.
In 2014, Community Care in Pennsylvania implemented a pay-for-performance program for Assertive Community Treatment (ACT) services, an evidenced-based model focused on treatment and habilitation. They collaborated with two Assertive Community Treatment (ACT) providers in Allegheny County and both providers achieved impressive results. In 2015, both providers reported a 64 and 28 percent reduction in the average inpatient cost per person per year, respectively. From the baseline year measure, one provider achieved a 76% reduction and the other achieved a 72% reduction in inpatient costs per member per year.
While the results have been positive where value-based care has been implemented, it’s still a challenge to base behavioral outcomes on quantitative results.
Some of the challenges around implementing value-based models in behavioral health settings include:
- Quality measurement
- Provider capacity
- Privacy and data-sharing
Measurement of results is also a challenge because there are fewer nationally recognized quality measures for behavioral health.
In an ever-changing landscape, healthcare professionals are continually working to find the best way to lower costs within the industry. One way to do this is to treat both behavioral and physical health together, rather than independently. Value-based care can help do that effectively and efficiently, leading to greater benefits and health for clients.