Defining Value-Based Care in Behavioral Health Population Management


February 27, 2017   Jacob Levenson

Value based careFor many years, doctors operated on a fee-for-service model, where services or treatments are individually paid for and administered to patients. This model created an unbalanced system, where doctors were incentivized to provide more treatments for the sake of revenue, even if they weren’t needed, because the more treatments they provided the higher the payout was for them. It rewarded quantity over quality. Luckily, that model is all but gone as the healthcare industry as a whole is moving towards value-based care.

AETNA does a great job of defining exactly what value-based care looks like. Essentially, it rewards doctors for keeping patients healthy on a long-term basis. This is especially true for patients with chronic conditions. Value-based care isn’t just limited to individuals though, it can also be used to improve the health of entire populations. The questions we are defining answers to here are:

  • How does value-based care work in a population?
  • What does value based care look like in Behavioral Health Population Management (BHPM)?

Value-Based Care and The Triple-Aim

Institutions transitioning to a value-based care model encounter numerous difficulties along the way. Often times, providers resist this transition because of the prospect of lower pay if they’re not immediately providing quality care under the new model. Providers can be incentivized during the transition process by using the Triple Aim as a roadmap. We know that the Triple Aim is comprised of these three objectives:

  • Patient Satisfaction: Improving the patient experience
  • Quality of Care: Improving the health of populations
  • Economic Efficiency: Reducing the per capita cost of healthcare

Unfortunately, in the BHPM space the Triple Aim isn’t clearly defined, but if you look at the core objectives of the Triple Aim it’s easy to see where it fits into behavioral health. In the BHPM space we achieve the Triple Aim by improving the patient experience through technology, optimizing quality care outcomes at an organizational level, and increasing economic efficiency across the care continuum.

Improving the Patient Experience Through Technology

Improving patient satisfaction in behavioral health requires taking a comprehensive look at the patient’s entire care journey, from admission all the way through post-treatment services and possibly beyond that. There’s no hard and fast rule for doing this, but one thing we do know for certain is that the utilization and personalization of digital tools has a direct effect on patient satisfaction and improves the entire patient experience.

In the pharmaceutical world, there’s evidence that proves that patient outcomes are improved through the use of digital tools, especially highly individualized ones that are integrated within the healthcare systems. These tools vary, but include mobile health, telehealth/telemedicine, health IT, wearable devices, and personalized medicine.

In BHPM, the utilization of technology is a vital component to the success of healthcare outcomes. Payers and providers have already been experiencing the benefits of the widespread adoption of telehealth, and the technological advancements this provides in post treatment support. We also know that Electronic Medical Health Records (EHR) and Health Information Exchanges (HIE) are critical tools in the collection of data. That data becomes the backbone for research on effective treatment modalities and the elimination of ineffective methods. This translates into effective treatment by providers which improves their success rates, solidifies their reputation, and leads to better care across entire populations over time.

Quality Care Outcomes Optimization at an Organizational Level

Optimizing the quality of care provided to entire populations is no easy task. The size of the organization can have a tremendous effect on the quality of care provided. This process takes careful coordination across entire departments, and in some cases multiple providers, over a period of time. Expecting this transition to happen instantaneously, or without thorough communication across departments is a recipe for creating setbacks.

Making sure the whole care coordination team has the same information is a key principle in behavioral health interoperability, and a necessary element in optimizing outcomes across the care continuum. This coordination produces effective providers that payers and patients alike can rely on for quality care.

Providing quality care isn’t limited to large organizations with access to more resources and personnel. It’s often easier for those organizations to transition to a value-based model because of their access to resources, but small practices focusing on value-based care are performing with incredible results. Reports show that they are capable of having lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.

Increasing Economic Efficiency for Patients, Providers, and Payers

Saving money and improving outcomes: that’s what value-based care aims to achieve. Providers and patients stand to gain several economic benefits from the value-based care model. By improving the patient population experience through technological innovation, individuals are provided with higher quality care, lower healthcare costs, and better long-term outcomes. By optimizing outcomes, providers reduce a lot of costly resources: emergency room usage, personnel wages, equipment usage leading to depreciation, and they save time--which could arguably be the most valuable resource of all.

On the other side of the coin, payers want to make sure the treatment they’re subsidizing has a return. Their goal then becomes rewarding value by looking at patient satisfaction and the quality of care. Providers that utilize the principles of the value-based care model effectively, will keep payers invested in them.

As we’ve discussed before, we know how difficult it is to define value. Those providers performing at the top of the field, who are identifying and delivering effective treatment, will be the ones who reap the long-term rewards (not just economic ones) within the behavioral health field.
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