While the world of physical medicine has seen a steady progression in the development and adoption of value-based care models and payer contracts, behavioral health has been on a slower road to adoption. At the 2020 Open Minds Performance Management Institute earlier this month, payers, providers, and vendors convened to discuss a number of topics related to where behavioral health services are on the road to value, and how the sector can move forward more quickly. There are certainly some issues that need to be addressed.
Before we delve into the question of how more provider contracts can be transformed into ones that provide financial incentives for lowering costs and improving quality outcomes, it’s important to take a closer look at market conditions affecting providers caring for: 1) patients with intellectual and development disabilities, 2) substance use disorder patients, and 3) those with a variety of mental health issues.
Funding for the care of these individuals is more limited, and there are shortages of licensed professionals to serve this population, particularly in rural areas. The ability to utilize data analytics and care management software applications is hampered by both the availability of leading-edge solutions and the cost associated with implementing and operating this software. While we are beginning to see solutions implemented in larger group practices, smaller practices don’t have the funds available to invest in more information technology.
Many of these issues were brought to light during an executive discussion group session titled “Technology – How Much is Enough?” Most provider groups and health systems in this space rely on their Electronic Health Record (EHR) solution to perform a number of other core business functions such as finance, human resources, and sometimes appointment scheduling. Discussion group participants agreed that these solutions are currently lacking in more interactive Population Health Management functionality that enables provider entities to drill down further than the current dashboard and report-generation systems they are equipped with.
This is where two separate barriers to value-based contracting converge. First, if provider entities don’t have the capability to drill down and pinpoint the issues causing gaps in cost-effectiveness and/or quality, it will more difficult for them to manage their value-based contracts and maintain financial viability. Second, there is still some work to do in identifying meaningful quality and cost indicators. Almost all quality measure sets such as HEDIS have somewhat limited applicability to mental health and substance use disorder treatment protocols. For example, a 7-day follow up after discharge is not the best indicator for long-term mental health status improvement. In addition, there are very few measures that pinpoint diagnosis-based health improvement. There are several measures that monitor status for anxiety and depression, but there aren’t many agreed upon measures beyond that.
Finally, the need for a true partnership among practitioners, payers and vendors was stressed throughout the two-day meeting. The cost for an office visit has been the traditional haggling point when behavioral health managed care entities sit down to negotiate a contract. There were certainly indications that this scenario is changing, but only time will tell whether true partnerships will become a sustainable model.
What do you think?