OpenMinds.com, a company that provides information and support to health care organizations, has posted two blogs recently that can provide potential ideas for developing and marketing your own value-based data about your services/program/clinic/agency.
These articles were written for health care organizations seeking new, or better, contracts with managed care companies, but have potential implications for smaller organizations, such as agencies and clinics; the suggestions may even be worth considering by small groups of independent mental health professionals that are seeking to survive, or even thrive, in the emerging value-based marketplace.
“Have the ‘Best Services, But No Health Plan Contracts?” was posted on 1-10-17. The author, Paul Block, Ph.D., begins by affirming that value-based payment models are not going away, but also many mental health programs are frustrated with the lack of a consensus about value-based measured for mental health services. He advice: create a system for tracking your own values measures and use your own data to assertively lobby for better contracts with insurance companies by demonstrating how your services save them money.
He notes that we really have two options – to either lower costs or improve outcomes (or, mhconcierge’s take: perhaps do a better job of documenting good outcomes that are already in place, but which do are not measured accurately, or at all, by insurance company outcomes measures). He notes that rates of reimbursement for our services are already so low that there is little potential benefit to insurance companies to manage their spending on mental health services. Rather, he advocates that we focus on the fact that much of the potential savings for mental health services “is not from behavioral health costs per se, but from the effects of treatment for behavioral health comorbidities on medical status and spending.”
In other words, we need to focus on how our services can save health plans money and improve outcomes for their more complex, and costly, members.
He ends with some specific recommendations. First, we should “..document the clinical outcomes of your services using currently recognized, valid measures.” And, we should not wait for insurance companies to reach out to us, or to establish values-based measures and provide them to us. It is time, he advocates, for us to develop our own effective, “value-adding” service models and to communicate them to insurance companies, with a focus on telling them how we are helping them with their needs (to both reduce costs and to improve outcomes).
“Building Your Own Definition of ‘Value’” was posted 1-20-17 and follows up on the previous article. The author, Jamie Stewart, begins by observing that many behavioral providers are struggling to demonstrate their value to payers, especially given that the payers have not yet developed their own “value” criteria. His advice: “…build a strategy for defining your own value by looking at what success means to your organization and the consumers you serve.” In other words, work on developing data about your organization’s clinical outcomes, and – like the previous author- “be assertive about proposing these models to health plans.” His clinic serves children and families, and he has developed a system that identified the ten most common reasons for referrals and tracks how the program is doing on each of these markers.
For clinics and agencies seeking to do something other than passively wait for payers to tell us how we will be measured, and paid, these articles provide some ideas of more assertive options. They could also possibly be options for progressive small groups of behavioral professionals who are savvy about using outcomes measures to document what a good job they are doing.