Value-Based Payments Are Coming to Behavioral Health, Ready or Not

Value-based payments (VBPs) have been a topic for discussion since the earliest days of the Affordable Care Act. Implementing them as a drop-in replacement for fee-for-service (FSS) payments remains a work in progress. But they are coming. They are coming to behavioral health whether the industry is ready or not.

The VBP concept is based on rewarding clinicians and healthcare facilities for providing quality care that leads to the most positive outcomes. It is more or less a pay for performance model. Is it something your facility already has experience with? If so, you know that VBP programs still have plenty of bugs to work out. Now is the time to get out in front of the coming VBP ecosystem.

Assess Your Organization’s Readiness

For the record, the Centers for Medicare and Medicaid Services is already implementing VBPs for a limited number of services covered by both Medicare and Medicaid. Medicare has even gone so far as to begin developing what they call Value-Based Programs. What does this mean to you? That it is time to assess your organization’s readiness.

Behavioral health management companies, including Horizon Health, are beginning to advise clients to take a good, hard look at how prepared they are to start accepting VBPs. A thorough assessment examines technology, financial practices, billing policies, cost reporting, revenue management, and any other factors that directly influence payment systems. If a facility’s systems cannot be transitioned to VBP seamlessly, there is work to be done.

Develop a Transitional Strategy

Transitional strategies are something we love in behavioral health management. We employ them all the time when developing programs and policies around patient needs. Now we need a transitional strategy to get from FSS to the newer VBP model.

This may require a realignment of your facility’s mission and vision. It may require a plan to encourage buy-in from reluctant stakeholders. Treat it like any other major project. Assign a project manager, put together a team, and get working on it. The sooner your facility has a transitional strategy in place, the sooner you can begin accepting VBPs.

Note that VBPs come with their own set of challenges your transitional strategy will have to address.

Those challenges include:

• Data Reporting – Healthcare providers will need a new way to collect and report data to reflect both value and patient outcomes. Developing new data reporting systems is time-consuming and costly. However, it cannot be avoided.

• Complexity – VBP ecosystems are complex. They will continue being so for the foreseeable future. You are going to need the best of the best to get your facility ready.

• Financial Risk – Implementing a VBP strategy presents a certain amount of financial risk to any healthcare facility. Mitigating such risks as much as possible is critical during the planning and implementation stages.

Much of the VBP landscape remains unclear. There is a lot about value-based healthcare that is only theoretical. Until it is implemented across the board and as the default standard, much of what we do to prepare for VBP will amount to trial and error.

Don’t Face It Alone

VBPs are coming to behavioral health whether the industry is ready for it or not. We encourage you to begin preparing for it now. We also encourage you to not face it alone. Take advantage of behavioral health consulting services that can help you align your facility or practice with VBP. Never forget that, as a behavioral health provider, your company still needs to maintain good financial health in order to continue serving patients. VBPs will be part of that moving forward.