Medicare and Medicaid are moving away from fee-for-service reimbursement models in favor of value-based contracts, and they want behavioral health care organizations to follow suit. Designed to prioritize quality improvement and promote better patient outcomes, value-based care is where the paradigm has shifted.
Value-based care is a framework of evidence-based practices known to deliver high-quality care and improve patient outcomes. Value-based reimbursements provide monetary incentives for health care systems to adopt value-based practices, develop systematic quality improvement measures, and focus their efforts on quality over quantity.
Although value-based criteria can significantly improve patient outcomes and deliver high-quality care that's also cost-effective, behavioral health clinicians have been slow to adopt them. Resources are lacking to support value-based programs, technology integration is challenging, and policies, regulations, and deadlines are constantly changing. However, it doesn’t have to be complicated. Here are five ways to ease into value-based care and improve patient outcomes.
1. Reduce Costs and Add Value
Lowering health care costs is a crucial component of value-based care. After all, when health care is affordable, more people have access to it. But more than cutting health care costs is required. At its heart, value-based care transformation is all about improving patient outcomes. You can do this by creating more value for patients. Strategies that merely focus on cost reduction may only deliver some of what value-based care has to offer. The following payment models illustrate how value-based payments accomplish both goals.
Value-Based Payment Models in Behavioral Health
Traditional fee-for-service payment models promote quantity over quality. Because payers base reimbursement on the number of services performed, it has motivated some providers to take on more patients than they can manage or order unnecessary tests and procedures. In addition, services are unbundled, meaning each is billed separately and at rates much higher than Medicare would charge. As a result, costs for health care skyrocketed under this model.
The federal government developed value-based care programs to reduce health care costs and improve patient outcomes.
Accountable Care Organizations
The provider assumes shared financial and regulatory responsibility and accountability for successfully managing the cost of health care, improving the overall patient experience, and improving the health of their respective populations.
Accountable care organizations (ACO) accept the financial risk of the patient’s health outcomes. When ACOs meet specific quality and cost-efficiency benchmarks, they are rewarded or penalized if they fail to achieve them.
Bundled Services (Payments)
Bundled services or bundled payments group bills from multiple services into a single payment at a discounted rate. While bundled payments are not a new policy initiative, they have resurfaced in the current health care reform era because of their ability to reduce costs while improving quality.
2. Integrate Systems of Care
Integrating behavioral health may improve patient outcomes, according to research. A recent study found that standard primary care patients were significantly more likely to experience depression and anxiety than those undergoing collaborative care. There are two types of value-based care interventions that rely on integrated care to improve patient outcomes.
Collaborative Care Model (CoCM)
A CoCM is a behavioral health integration model that incorporates critical services to enhance care for patients whose conditions aren’t improving in a traditional program. The collaborative care model in behavioral health may refer to:
- A team-based program led by a primary care provider who works with a care manager and consults with a mental health specialist. The team collaborates to provide treatment recommendations when patients aren’t meeting their clinical objectives.
- Population-based care, in which the care team monitors treatment progress through a registry.
- Patient-centered, proactive outreach promotes self-management, treatment adherence, and coordination of services to engage, activate, encourage, and activate patients.
- Measurement‐based, with screening and monitoring of patient-reported outcomes over time to assess treatment response.
- Evidence‐based, with demonstrated cost‐effectiveness in diverse practice settings and patient populations.
Integrated Care Model
Similar to but less formal than CoCM, the integrated care model uses a team-based approach to support collaboration and communication of health care professionals across medical specialties and health care settings to improve the patient’s health and well-being. To improve health in our communities, it’s vital to integrate behavioral health services across the continuum of care.
3. Empower and Engage
Patient engagement inspires active participation and is associated with better health outcomes. Moreover, it’s easier for engaged patients to follow their treatment plans, take their medications, and follow their providers’ recommendations. Two value-based models of care encourage high levels of patient participation.
The shared decision-making model of care refers to the collaboration between the patient and the health care provider in which the patient is a full partner in the decision-making process. It provides the patient with objective information concerning the disease process, prognosis, treatment options, conditions to be prevented or treated, costs, and benefits.
Centers for Medicare & Medicaid Services (CMS) defines patient-reported outcomes as information directly provided by patients about their treatments, conditions, or behaviors. The data is strictly subjective, with no meaning assigned by clinicians. Patient-generated information offers a unique perspective and may reveal insights related to:
- Quality of life
- Healthy and unhealthy behaviors
Patient-reported outcomes allow patients to participate in the process by determining which outcomes are the most important. Technology like digital surveys and questionnaires are helpful patient-reported outcomes measures (PROM) for the behavioral health setting.
4. Identify and Mitigate Risks
To achieve the highest health and quality of life possible for patients, it’s necessary to identify and mitigate risks so that chronic diseases can be prevented or stabilized and costs can be reduced. Risk stratification assists health care providers in customizing their patient education and patient engagement efforts to fit the patient.
Risk-Stratified Care Management
The risk-stratified care management (RSCM) process involves assigning patients a health risk status and developing and implementing a care plan tailored to their needs. When used alongside decision support tools, risk stratification may help care providers spot early signs of relapse and medication non-compliance.
Clinical Decision Support
A clinical decision support system (CDSS) improves the safety and efficacy of health care services by enhancing medical decisions with targeted clinical knowledge, patient information, and other health metrics.
Diagnostic support, disease management, prescription management, and risk management are some of the functions that CDSS performs to improve the quality of care. There are many types of clinical documentation a CDSS can provide, such as electronic medication records, order sets, patient data reports, and clinical workflow templates.
5. Use Behavioral Health Technology to Improve Patient Outcomes
There are numerous opportunities to improve and transform health care delivery through technology. Positive patient outcomes associated with the meaningful use of technology include reducing human error, improving clinical efficiency, facilitating care coordination, improving the patient experience, and developing data-driven strategies for better care.
ContinuumCloud’s behavioral health software solutions include a comprehensive EHR with a patient portal and practice management features, multiple communication modalities, and the CaredFor patient engagement app.
Comprehensive EHR Solution
Electronic health records can influence clinical outcomes and support value-based care in multiple ways:
- Supports provider decision-making in real-time with clinical information across the continuum of care
- Provides caregivers with information about possible medical errors for improved patient safety and fewer adverse events
- Standardizes clinical documentation and order sets, consistent with evidence-based best practices
- Improves preventive care utilization through reminders and follow-up messages
- Enhances communication between care providers and patients
- Improves patient satisfaction with self-service features like online scheduling
- Gives patients access to their behavioral health records via a secure patient portal
CaredFor Patient Engagement App
Patient engagement promotes better outcomes while decreasing costs and providing access to high-quality behavioral health care outside of the traditional care setting. The CaredFor app by ContinuumCloud features:
- HIPAA-compliant messaging
- Educational content library
- Customizable surveys, follow-up questionnaires, and self-care assessments (perfect for PROM)
- Private messaging
- Telehealth access
- Contingency management capabilities
- Moderated peer support community and in-app social-media experience
Are You Ready to Improve Outcomes With Value-Based Care?
Value-based care holds great potential for improving patient outcomes and delivering high-quality care. Switching from a fee-for-services model may seem daunting for some behavioral health care systems needing more resources and technical understanding.
However, the CaredFor app, ContinuumCloud's patient engagement solution, as well as ContinuumCloud’s ER solution, offer the tools and resources you need to get started with your value-based care model. We can also help you design a value-based digital transformation plan. To learn about more ways we can help you succeed, contact us today.