Programs Will Seek to Maximize Value-Based Care Model

Forward-thinking leaders aspire to be part of a healthcare system that prioritizes value over volume. A central component of health reform is moving the healthcare industry from fee-for-service reimbursement to a payment model based on quality of care. While the mental health and addiction treatment community stands far from realizing the full potential of value-based contracting, some of the field’s leading voices are making a strong case for this paradigm shift.

Nationally regarded addiction treatment organization Caron Treatment Centers has engaged in value-based contracting for more than five years. As reported in 2021 in Alcoholism & Drug Abuse Weekly, the eastern Pennsylvania-based Caron launched a pilot value-based contracting agreement with Independence Blue Cross in 2017. The arrangement placed Caron in greater control of managing patient care, but with an important condition: It would be on the hook to pay for any return treatment needed within 90 days of a patient’s discharge from residential care.

Some might see this as overly burdensome to the provider, but Caron could boast of having the lowest 90-day readmission rate among providers in the Independence Blue Cross network, the newsletter reported. As Caron’s then-chief medical officer Joseph Garbely, D.O., said in the newsletter article, “The important thing to understand here is we’re trying to make outcomes better, just like physical medicine.”

Garbely went on to say, “Programs haven’t been held to accountability, and this is a way of holding us accountable.”

Value-based payment opens a wealth of possibilities for behavioral health providers and their patients. Payment that is based on performance forces treatment organizations to rely on evidence-based interventions and to view their patients holistically, rather than by a diagnosis alone. The move to value-based care has given rise to bundled payment models that can reward services meant to address the “social determinants of health” that are so critical to a healthy recovery, such as housing support services.

Value-based models also give payers a more accurate picture of the impact of the services they are financing. As former managed behavioral health care administrator and current consultant Ed Jones, Ph.D., writes this week for Behavioral Healthcare Executive, “This can help reorient the field financially. We can move from decrying the chronic underfunding of behavioral healthcare to using new metrics to justify increased funding. That is why many are excited about value-based care contracting.”

Many challenges persist as behavioral health seeks to catch up to the general health community in implementing performance-based models. Barriers to greater integration with primary care remain, with many in the general health community still viewing addiction and mental health as subordinate interests that lack a scientific basis. These stigmatizing views ignore the enormous impact untreated behavioral health conditions have on medical care costs, and how fully integrated care could save the system billions.

Of course, the behavioral health community itself bears some of the responsibility for the slow uptake in value-based arrangements. Facing the common criticism of lacking objective measures for tracking patient progress, the field needs to embrace more fully the available evidence-based instruments for outcome evaluation. Leaders also should push for more standardization of quality-of-care measures in addiction and mental health treatment.

Arguably the most critical area for improvement lies in data collection. As Jones writes in his Behavioral Healthcare Executive commentary, “Generally speaking, our healthcare system needs to become more agile and effective at gathering and using clinical information. [Measurement-based care] is our leading edge.”

Data collection must be integrated into treatment centers in a manner that doesn’t overburden clinicians, who already face increasing responsibilities as they are asked to provide more comprehensive care. As we wrote back in February, pioneering organizations such as Caron have figured out how to implement meaningful data solutions that end up saving time for busy clinicians and managers. Caron’s work with us at Sigmund Software, which preceded its efforts in value-based contracting, helped to define the EHR platform that became our AURA solution.

Partly because of its traditional separation from general healthcare, the behavioral health community overall has not leveraged the power of technology in guiding treatment. We are committed to being an influencer of positive change in this direction. Our dynamic end-to-end solution is designed specifically to meet the needs of behavioral health providers, and our team is committed to understanding and adjusting to each of our clients’ priorities.

Actionable data will allow mental health and addiction treatment providers to maximize performance and flourish in the value-based payment systems that will come to dominate the healthcare landscape.