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 providers for 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 that patients in a value-based healthcare model have fewer doctor’s visits, medical tests, and medical procedures. Additionally, they pay less for medication as their health gradually improves. BlueCross BlueShield entered 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 designed to treat the whole person effectively,” 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 substance use disorder diagnoses.”
It is essential that BlueCross BlueShield ally with Value Network. Because of this alliance, 23 providers licensed through OASAS, the New York State Office of Mental Health, and the Home and Community-Based Service Providers (HCBS) entered its network.
The contract contains an upside-risk agreement that 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 designed to treat the whole person effectively,” 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 has 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 provider’s exact focus with the help of an X-ray report. When a patient complains 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 cannot identify the cause and correctly diagnose the root of the complaint, 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 exemplifies how these two disciplines can work together.
One physician from an orthopedic practice adopted this procedure and reduced the number of orthopedic procedures his clinic performed by nearly 50% while increasing the number of patients treated using different modalities. Looking at these numbers to see the future is a prime example of using value-based care in behavioral health.
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FAQs
1. What is value-based care in behavioral health?
Value-based care in behavioral health focuses on treating the whole person mentally and physically, rewarding providers for delivering high-quality care.
2. How does value-based care benefit patients?
Under this model, patients experience fewer doctor visits, reduced medical tests, and lower medication costs as their overall health improves.
3. What is the BlueCross BlueShield and Value Network partnership?
BlueCross BlueShield partnered with Value Network to introduce a payment model that enhances quality care for mental health and substance use disorder patients.
4. Why is screening for behavioral health conditions necessary in value-based care?
Screening helps identify underlying behavioral issues, like anxiety or depression, that may manifest as physical pain, ensuring holistic treatment.
5. How does value-based care impact treatment approaches?
By focusing on the whole person, practices can reduce unnecessary procedures and adopt more effective treatment methods, improving patient outcomes.
