By Todd Charest, Qualifacts
Over the past several years, federal and state programs, grants and commercial payers alike have embraced value-based payment (VBP) models in an effort to improve care quality and slow cost growth. While this shift began in the physical health sector, it is now permeating behavioral health. Given the costs associated with behavioral health, it’s no surprise the industry has united in pursuit of greater value.
In fact, spending for individuals with a behavioral health diagnosis is almost four times higher than for those without. Around 20 percent of patients with a behavior health diagnosis account for nearly half of total Medicaid expenditures.
The industry can no longer afford to leave behavior health on the value-based care sidelines. Included within MACRA as an advanced-alternative payment model (APM), the program will require providers to account for a patient’s social, behavioral and psychosocial status. This requirement is set to begin in 2019, yet behavioral health leaders vary in their readiness for this value-based care transition.
The move to value-based care will likely also mean more administrative and compliance regulations, expanded documentation needs and potentially more denials. To be successful, there are three key ways behavioral health leaders can use their EHR to improve clinical care and achieve better outcomes.
Many providers today measure outcomes solely for compliance purposes. Though value-based payment is still emerging for behavioral health, it’s important for organizations to start meeting benchmarks before they are paid on them. This proactive approach will ensure data is leveraged and integrated into quality initiatives to thrive the new value-based care environment.
An EHR should be a robust, configurable performance management system that makes it simple to measure and improve the quality of services within the clinical workflow. This enables better reporting and analytics that enable providers to improve outcomes clinically, financially and operationally – without increasing staff burden.
Reporting on quality measures lets you assess and improve quality of care and resource utilization. Utilization management, and the ability to right-size your resources, helps balance the competing needs of high risk patients who require complex care and those requiring less intensity. A configurable system can also align metrics with evidence-based practices and federal value-based reimbursement programs, like Certified Community Behavioral Health Clinics (CCBHCs), MACRA and Meaningful Use. In a value-based world, having integrated assessments and tools for consumer-reported outcomes and measures is increasingly important.
The ability to collaborate and share data is essential to achieve better care outcomes. Teams should be able to access the actionable information they need when they need it. An EHR that offers clinical decision support and content libraries at the point of care helps the provider adhere to the best care guidelines. This data can also support shared decision making by facilitating more informed discussions between patient and provider.
It’s important to consider the ability to share information across remote locations, with outside providers and when away from the internet. Equally as significant as point-of-care support, community-based staff must be able to access data and document services while away from physical locations and, at times, without internet access.
Community HealthLink, Inc. (CHL), a behavioral healthcare provider based out of Worcester, Mass., is one organization that recognized this need and is leading by example. Advocating on behalf of underserved populations in their community, CHL required a solution that would meet the unique needs of the populations they serve, and enable improved collaboration and information sharing with primary care organizations.
“There are many EHR vendors out there, but we need a platform designed specifically for behavioral healthcare providers like us,” said Nicole Gagne, President of UMass Memorial – Community Healthlink, Inc. “With our new behavioral health-specific solution, we can collaborate more effectively with primary care providers to provide the best-in-class care our clients deserve.”
Leveraging technology customized to the industry, CHL is able to more effectively leverage data to optimize the care they provide to individuals with behavioral health or substance abuse issues.
In addition to supporting better care and clinical outcomes, accessible data is an important factor when considering payer interactions. A behavioral health EHR has the capability to produce reporting views that can be share with payers, funders and other stakeholders.
There are several ways behavioral health leaders can support revenue integrity when faced with the challenges value-based care initiatives introduce. Organizations can prepare by optimizing staff efficiency and identifying and minimizing potential revenue risks—all while protecting and growing their bottom line revenue.
Streamlined workflows and integration can help reduce the cost of time-consuming, repetitive tasks. Shifting payer and compliance requirements need thoughtful and impactful measures that ensure revenue protection. By implementing effective processes—and an EHR that supports these processes—organizations can reduce the potential for denials and under payment. This starts before the Point of Entry and continues throughout the Golden Thread, culminating at final billing, and then repeats.
By following the journey toward value-based payment that has been experienced in the institutional market, organizations may see an increase in denials, and in turn, the need to rework submitted claims, potentially resulting in lost efficiency and revenue as well as possible future audits. Because outcomes are tied to revenue, billing should connect with outcome measures, and the tools for collecting quality indicators need to be part of that equation. EHRs are systems of truth, and that must calculate into trust. The right platform should capture these measures, consider the reimbursement models, and help guide providers toward maximum benefit. This results in continued care for patients, improved staff efficiency, quicker and fairer payments, and ultimately higher satisfaction with their choice.
Find The Right Partner
The accelerating transition to value-based care is leading more behavioral healthcare organizations to create strategic partnerships that help them better leverage their data and meet the specific requirements of behavioral health populations.
A robust EHR platform for behavioral health and human services can help organizations optimize clinical, financial and operational outcomes to succeed in a value-based care world. As the industry embraces value-based care, the right EHR partner has the ability to drive performance, maintain revenue integrity, manage risk and stay ahead of the ever-changing regulatory and payer landscape.