Value-Based Reimbursement in Behavioral Health

The behavioral health industry has historically lagged behind physical healthcare in adopting value-based and outcomes-based care models. Value-based care is also known as accountable care. A value-based care system is focused on getting value from quality services. Value-based healthcare is a payment system that rewards healthcare providers in accordance with the quality of care provided to their patients. Payments are based on better health for populations and other things, such as cost reduction, which can lead to a focus on preventative care.

The benefit of value-based care is a patient in a value-based healthcare model will have fewer doctor’s visits, medical tests, and medical procedures. Additionally, they pay less for medication as their health gradually improves. BlueCross BlueShield came into the value-based reimbursement arrangement with Value Network. The provider group has 100+ providers in behavioral health care in Western New York.

“This is another step we’re taking to build a behavioral health care model that’s designed to effectively treat the whole person,” said Dr. Thomas Schenk, Senior Vice President, and chief Medical Officer, of BlueCross BlueShield of Western New York. “BlueCross BlueShield of Western New York is proud to partner with the region’s leading behavioral health care providers to introduce the first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses.”

It is important that BlueCross BlueShield allied with Value Network. Because of this alliance, 23 providers entered into its network who have been licensed through OASAS as well as the New York State Office of Mental Health and the Home and Community-Based Service Providers (HCBS).

The contract contains an upside-risk agreement and it follows the payer’s best practice approach to value-based reimbursement for primary care providers.

“This is another step we’re taking to build a behavioral health care model that’s designed to effectively treat the whole person,” Schenk said of the value-based reimbursement arrangement with Value Network.

Value-Based Behavioral Health

What is meant by adopting a value-based model in the behavioral health sector? It requires the whole person physically and mentally, not just addressing a specific complaint or ailment.

When a patient with a broken arm, a medical provider x-rays the arm, finds the pain area, and creates a treatment plan that will focus on the arm. This is a very simple case; it shows the exact focus of the provider with the help of an X-ray report. When a patient is with complaints of anxiety, extreme fatigue, or signs of depression, this time the whole person must be examined to find out the exact reason behind this.

There are some instances where a patient presenting with pain could be experiencing behavioral issues that are manifesting as pain. If a medical provider is unable to identify the cause and properly diagnose the root of the complaint then the patient could go untreated.

Now, many practices will start screening all patients for behavioral conditions, like depression or anxiety, before scheduling surgery. This practice ties the knot between behavioral and physical health and is an example of how these two disciplines can work together.

One physician from orthopedic practice adopted this procedure and reduced the number of orthopedic procedures that his clinic was performing by nearly 50% while increasing the number of patients treated using different modalities. Looking at these numbers to look at the future is a prime example of using value-based care in behavioral health.

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