Reinventing compensation strategies together: A unified journey in mental health treatment
In the realm of behavioral health care, a shift towards deeper and more collaborative partnerships between payers and providers is gaining momentum. This new approach is centred around value-based care models, enhanced data transparency, and integrated care workflows, all aimed at improving outcomes and reducing costs.
At the forefront of this movement is a speaker who recently participated in a panel at the Becker's Behavioral Health Summit. With experience on both the payer and provider sides of healthcare, the speaker emphasised the importance of behavioural health, stating that there's no health without it, and mental health being the leading cause of disability in the U.S.
One key element of these strategies involves value-based payment models. Payers and providers are moving beyond traditional fee-for-service to case rates, bundled payments, shared savings, and hybrid capitated arrangements. These models incentivise providers to deliver sustained engagement and clinical improvement while managing costs.
Integrated care and care navigation are also crucial. Behavioural health providers are embedding their services within broader healthcare systems, including primary care workflows and payer care management teams. This integration supports coordinated, whole-person care, particularly for complex behavioural health cases such as psychosis and treatment-resistant depression.
Real-time data sharing and transparency are essential for success. Advanced platforms leverage data transparency to enable seamless coordination among payers, providers, and care teams, thereby improving clinical decision-making and reducing redundancies.
Technology and digital mental health solutions are playing an increasingly significant role. The Centers for Medicare and Medicaid Services (CMS) is expanding billing codes and Medicare reimbursement for integrated behavioural services and digital mental health therapies. This facilitates the incorporation of digital tools into care models and enhances provider-payer collaboration through shared data platforms.
Best practices playbooks for payment and data sharing are being developed to ease participation and align expertise with payer partnerships. Groups like the AMA and health systems such as Henry Ford Health are creating these playbooks outlining best practices for voluntary adoption of value-based care (VBC) arrangements and data sharing.
Community-based service expansion is another focus area. Medicaid and state policies prioritise investments in Certified Community Behavioral Health Clinics (CCBHCs) and community services. Enhanced and alternative payment options, quality-based bonuses, and funding realignments support expanded access and integration with social services, thereby reducing ER visits and inpatient admissions.
In summary, these strategies emphasise value alignment through innovative payment models, deep clinical integration across the care continuum, and transparent, real-time data exchange, leveraging technology and community resources to enhance outcomes and lower total costs in behavioural health care.
However, a system that delivers on its promise requires aligned data, common definitions of quality, and a commitment to sustained care. Currently, there is no shared definition of high-quality behavioural care across the industry. Robust EMR data and engagement trends are tracked at the speaker's platform.
More organisations are collaborating in the behavioural health industry, showing a shared purpose to achieve parity and improve treatment. Alignment on outcomes is crucial to scaling effective solutions in behavioural health care. Combining datasets can provide understanding of factors driving improvement in outcomes and reduction of total cost of care.
Everyone in the behavioural health industry cares deeply about doing the right thing and ensuring people receive the treatment they need. Aligned incentives are necessary for ensuring coordination across the healthcare system, rewarding outcomes rather than just presence.
Navigating different interpretations of quality and value is challenging with 155+ payers. The solution proposed is data and transparency in behavioural health care. Partnership in the behavioural health industry is necessary to make progress.
- In the sphere of behavioral health care, there is a growing emphasis on science, particularly in the form of digital mental health solutions and advanced platforms that leverage data transparency for improved clinical decision-making.
- The integration of health-and-wellness, including mental health, into primary care workflows and payer care management teams is crucial for coordinated, whole-person care and reduced costs.
- To achieve parity in behavioral health care, there is a need for education-and-self-development, such as best practices playbooks for payment and data sharing, to align expertise with payer partnerships.
- The business aspect of behavioral health care is evolving, with technology facilitating the incorporation of digital tools into care models and enhanced provider-payer collaboration through shared data platforms.
- General-news on collaborative initiatives within the behavioral health industry, like the expansion of community-based services and investments in Certified Community Behavioral Health Clinics (CCBHCs), show a commitment to improving mental health outcomes and reducing costs.
