How to Prepare Your Organization for Value-Based Care

It’s coming and Procentive is here to help in your transition!

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Paving the Way for Wraparound Care

Providers using Procentive are well aware that physical trauma can have a lasting impact on clients’ mental state and behavioral patterns. Unfortunately, there isn’t always a clear way for medical and behavioral professionals to communicate as they help a client.

Value-based care will help solve this by paving a way for simplified communication, information-sharing, and wraparound treatments to help clients heal in mind and body. This wraparound care will hugely benefit the entire health system and can help increase the public’s understanding of the importance of mental health.

Adoption Challenges for Behavioral Health

Value-based care has been around for more than a decade but implementing this system has proven challenging for healthcare facilities in general but particularly for behavioral health clinics as it is an outcome-based model. More attention is being given to mental health and substance abuse recovery than ever before, which is great news for clinics and clients alike. At the same time, value-based payment (VBP) is gaining traction in the healthcare industry especially after the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which changed how doctors who see Medicare clients are paid.

However, behavioral health practices are slower to adopt this model than the rest of the healthcare industry. Keep reading to learn more and discover 3 steps behavioral health agencies can take towards implementing value-based care.

Value-based care and the Triple Aim

Value-based care is the idea that health care providers should be incentivized to provide the best possible care at the lowest possible cost. However, most providers are still using volume-based care models, which incentivizes high-profit margins often to the detriment of the quality of care provided. 

Value-based care can be a vague and confusing term, which is why in 2008 the Institute for Healthcare Improvement (IHI) developed the Triple Aim which is defined as “improving the individual experience of care; improving the health of populations and reducing the per capita costs of care for populations.” In 2010, Triple Aim gained steam when it was rolled into the Patient Protection and Affordable Care Act (ACA).

What will change when value-based care is implemented?

As the healthcare industry shifts from volume-based care to value-based care, the hope is that it will bring down costs for clients while delivering better results. Physicians, therapists, and social workers are optimistic about this new model and are excited about being able to deliver the high-quality care they pride themselves on without the worry of adding burdensome costs to those under their care. However, many providers do not have the data or tools needed to help them and their practices manage this shift.

Because general healthcare has been the first to move toward value-based care, the behavioral health industry can take the findings as a “hint” of what could happen for the behavioral side of health. For instance, 72% of physicians consider cost data valuable but only 28% of physicians receive cost information, which harms their ability to find low-cost lab and imaging options, identify high-quality nursing facilities or rehab centers. Sharing this data isn’t just beneficial to clients but can help facilities cut costs. In the two months after piloting sharing relevant cost data, the Texas Hospital Association saved $430,444. For behavioral health agencies that often operate on slimmer margins, the financial returns of investing in value-based care could pay off in a big way.

But it won’t just benefit agencies’ finances. When value-based care agreements are in place, many parties benefit. Patients will be able to improve their health for a reduced cost, especially in cases of chronic disease and other long-term or complicated health challenges. Providers will have access to more knowledge-sharing, which will increase their efficiencies and allow them to deliver more targeted, evidence-based care to their clients. Suppliers and payers will find an equilibrium where price, risk, and patient outcome balance, which will ultimately lead to a healthier society and lower costs-of-care.

What are the barriers to implementing value-based care at behavioral health practices?

Behavioral health practices have been slower to adopt value-based care methods than their medical counterparts. Part of the reason for this is that behavioral health practices are typically smaller, use software systems (or paper) that don’t speak with each other, and the type of care they provide revolve around tailored solutions.

The other main reason is that there is a lack of standardized metrics on outcomes when providers treat behavioral health and substance-use conditions. 

3 Ways to Overcome Barriers to Implementing Value-based Care

#1

Data Integration Updating IT Infrastructure

Electronic health record (EHR) platforms, like Procentive, are required for data integration. The lack of an EHR hampers information-sharing efforts and is detrimental to building standardized metrics.

EHRs help both medical and behavioral health providers communicate. For instance, if a patient has a hip replacement and experiences psychological trauma from the accident or surgery, physicians and therapists can work together by sharing data to provide a holistic approach to that patient’s health.

Updating data and IT infrastructure is the first step to better data and collaboration, which is the next key to moving towards value-based care.

Pro Tip:

 Fill out session documentation completely, and timely to ensure full capture of relevant data.

#2

Data Management & Data Sharing

As value-based care becomes the norm, clear and actionable data will become increasingly important. Providers should examine their data streams to see what gaps exist, understand how the metrics they currently are tied to outcomes, and make sure they are regularly collecting the data they need. The key is good data. Better outcomes are simply not possible if there are gaps in data or “bad” data in the system in the first place.

Behavioral health practices will need to begin using their data to define measurable outcomes. While this is a large task, collaborating between practices and utilizing national resources like insurance providers can help increase the amount of data to glean clearer patterns. Practices will need to navigate privacy concerns and how to protect their own competitive advantages while still increasing collaboration so clients can benefit and everyone can save money.

Pro Tip:

Keep your database tidy by discharging clients in a timely manner and appropriately managing program admissions, transfers, and discharges.

#3

Increasing Patient and Provider Engagement

Patients and providers alike can agree that they want better health outcomes. Practices that communicate effectively with staff and clients about what is expected from them and what will, and won’t change, will have an easier time during the transition. Sometimes this calls for a physical restructuring of a location to make the patient at the center of care. Sometimes it’s as simple as adding a few questions to an initial intake form.

Patients can be engaged in many ways but one of the most critical for providers will be tracking the entire patient journey, especially focusing on preventative and post-care behaviors. As providers implement new data streams, such as utilizing data from wearable devices like Fitbits, they must also communicate to the patient why this is important not only to their health but to their budget.

Pro Tip:

Streamline your billing data and processes to ensure your billing data is up-to-date.

The Bottom Line

Make sure your agency doesn’t fall behind the industry by understanding what it will take to move towards value-based payments now. Data management will be more important than ever, as will collaboration. Behavioral health clinics will need to increase the data they measure as well as analyze it. Tracking all this information can be tricky, however, which is why it’s important to partner with Procentive to help you navigate your way into data-informed, value-based care.

Are You Ready for Value-based Care?

Schedule a demo and we’ll show you how Procentive will make sure you are!

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