How Value Based Reimbursement Models are Changing Patient Care

How Value Based Reimbursement Models are Changing Patient Care

Of the many changes in the healthcare industry, one we’re looking at closely is the shift from volume-based to value-based reimbursement. The value-based reimbursement model, one that encourages providers to deliver the best care at the lowest cost, has already been adopted by the Centers for Medicare & Medicaid Services (CMS) and several large insurance companies, including Aetna and Cigna.

As opposed to paying providers a particular fee for a particular service, value based reimbursement models aim to encourage providers to deliver the best care at the lowest cost. This model is seen as a boon for payers, as it’s a way to keep costs down while maintaining the quality of care.

But this form of holistic, whole-person, care may also be a boon for behavioral health providers – so long as they begin to embrace the value-based model. This is because the regular behavioral health screenings and early intervention that forms the bedrock of this type of collaborative care may take the stigma out of behavioral health treatment. For this reason, behavioral health professionals just may see themselves providing less care to more patients.

This, of course, will challenge smaller facilities to grow in order to maintain financial viability. But providers may not need more beds in order to service greater patient populations. That’s because outpatient care and preventative screenings will take the place of inpatient care that occurs further along down the road.

We are, of course, a long way away from this healthcare utopia. At this point, 9/10 Americans in need of addiction treatment do not receive the care they need. And, by the time they do receive care, their dependency could be so far along that they need more care, not less.

In the interim, it’s important for behavioral health providers to not only measure the performance of their care on a continual basis, but to use the methodologies known to have the greatest positive impact on patient health.

This need not be done in a vacuum. The Joint Commission has a database of accountability measures that providers can source to ensure they are using the most recognized and proven treatment methodologies available. Whether those methods jibe with what’s covered by an individual patient’s insurance provider is another issue altogether.

While it may be frustrating to use one methodology on Patient A and another on Patient B simply because Patient A’s payer does not recognize the value of Patient B’s treatment, it’s important to recognize that this is where we are right now in healthcare. But we might not be here for long. Once the data is in, this moment of fragmented care may lead to a future of standardized care and more effective patient outcomes.

This is good news for everyone – patients, providers and payers alike.

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