Driving Healthy Results

Value-based care is a reimbursement model that rewards or incentivizes quality clinical outcomes. In the context of behavioral health, value-based care varies across facilities, communities, and states. The Centers for Medicare and Medicaid Services (CMS) is driving innovation, application, and guidance around value-based care within behavioral health. The overarching operational definition of value-based care is payment “for healthcare services in a manner that directly links performance to cost, quality, and the patient’s experience of care.” As more emphasis and investment are made in behavioral health, the industry can expect an increasing focus on quality outcomes that are tied directly to reimbursement.

Health equity defines an approach to care that ensures access to care and optimal outcomes regardless of their racial, ethnic, socioeconomic, geography, sexual orientation, gender, or other factors that have historically compounded health disparities. Within the context of behavioral health, health equity is spearheaded by the Office of Behavioral Health Equity. Policies, processes, and information standards are at the heart of the organization’s strategy and measures of success.

Both healthcare providers and support staff in behavioral health facilities are constantly working to provide patients with the best care possible while managing increasing demand, tight margins, and staff burnout. Substance use issues and access to care are worsening, creating higher demands on existing providers and treatment facilities. And reimbursement disparities whereby behavioral health providers are reimbursed at a lower rate than non-behavioral health providers persist; out-of-network utilization (self-pay) continues to increase, with rates growing by 20 percent between 2015 – 2017. While technology alone cannot fully address these issues, it can serve to reduce administrative demands and distraction, improve care coordination, and optimize reimbursement.

When your staff admits a new patient to your facility, it’s key that you keep track of the patient’s information in a simple, streamlined way. Many behavioral healthcare facilities struggle with record duplication, which can result in mistakes in patient care and unnecessary work. Electronic medical records (EMRs) comprise software that facilitates care coordination and workflow, enables HIPAA-compliant communication, and streamlines and billing process to reduce risk.

It’s key to manage relationships with patients and their families, and it can feel impossible to figure out how to stay on top of each patient’s needs without a software system designed to specifically support behavioral health. Customer Relationship Management (CRM) software empowers providers and staff so that they have visibility into the attraction, conversion, and retention of patients into a facility. It also provides the ability to track referral sources to help manage business development and marketing spend.

When you run a behavioral healthcare facility, you need to know what’s working financially–and what’s not. Revenue cycle management (RCM) provides valuable insight into billing processes and can help lower denials and delays in reimbursement. It starts when the care episode is created—from registration to admission through to discharge and ongoing alumni management. While RCM may appear straightforward, it is more complex than it seems. New payment models that shirt reimbursement from fee-for-service to value-based care drive new complexity and variables that behavioral health providers must accommodate to ensure optimal revenue.

Telehealth leverages multiple technologies to create virtually connect patients to providers. According to the American Telehealth Association, the most common types of telehealth include, virtual visits, remote patient monitoring, and other technology-enabled modalities that drive provider-to-provider connection, data transition, communication, and patient engagement.

In behavioral health, it’s important to stay in touch with both current and past patients to understand how they’re progressing in their recovery. Alumni management facilitates ongoing connections with discharged patients and empowers providers with the ability to identify patients who may be in need of additional services to help them continue in their recovery.

An effective behavioral health technology solution must accommodate the unique workflows, protocols, and populations served by diverse providers. Here are the top six things to look for when assessing a behavioral health solution:

• Support for the entire treatment pathway
• Behavioral health-specific workflows, functionality, and alerts
• Ease of use
• Transparency
• Interoperability
• Affordability

The National Alliance on Mental Illness (NAMI) defines patient engagement as “the strengths-based process through which individuals with mental health conditions form a healing connection with people that support their recovery and wellness within the context of family, culture and community.” As the industry continues to press into outcomes-focused, value-based care, patient engagement will take a more central and pivotal role as a standard for mental health care in the United States.

Behavioral health is one of the more complex segments within the healthcare industry because it encompasses so many aspects of healthcare. Mental health falls under the umbrella of behavioral healthcare, as do many other types of care. Behavioral healthcare providers address patients’ emotional, mental, and physical health, offering a range of services based on condition, co-morbidities, and treatment protocols.

Behavioral healthcare providers may work with a specific population of patients (such as patients with autism) or may provide a broad range of services (such as interventions for children with various behavioral diagnoses). Regardless of the population they serve, it’s important that behavioral health facilities manage patient relationships, maintain accurate electronic records, and create a revenue cycle management process that ensures prompt payment.

There are many different services provided by behavioral healthcare facilities. Drug and alcohol behavioral facilities may provide detox—a medically supervised process that safely removes drugs and alcohol from the body—while also providing the mental health support necessary for patients to begin the recovery process. Other drug and alcohol behavioral facilities may focus strictly on the rehab process, working with patients who have already gone through detox to help them begin the process of living a life without drugs and alcohol.

Other behavioral healthcare facilities focus on the intersection of mental and physical health, helping people who are living with mental health diagnoses get the medication and therapy that they need to live a healthy life. Behavioral health facilities may be general or may focus on a specific psychological or psychiatric need. Some facilities offer outpatient care, while others offer inpatient programming. Some offer intensive outpatient or partial hospitalization programming, a hybrid of inpatient and outpatient care that allows patients to get the help that they need in the time they have available.