By Sean B Jones
Does your organization track the effectiveness and quality of Behavioral Health care How do you measure effectiveness and quality of behavioral health? Are your measurements of behavioral health linked or correlated with claims data? Are your providers providing quality services? Are your providers effective? Are your providers receiving continuous feedback from their patients on the outcomes of treatment?
These are critical questions Managed Care and Provider Organizations should be asking in today's changing health care environment. The trends in health care are moving toward the measurement of the effectiveness of health care and linking the outcomes to performance based reimbursement strategies.
The Effectiveness of Treatment
Behavioral health treatment is very effective, especially when combined with medication and psychotherapy. However, the history of measuring the effectiveness of treatment is marked with tremendous variability in outcomes from one patient to the next.
This variability in outcome measures has somewhat lead the behavioral health field to be reimbursed differently from other specialties. Consequently, the reimbursement of behavioral health services has differed in reimbursement method and in the amount or value of reimbursement relative to other like specialties. The field of behavioral health continues to struggle on how to measure the outcomes of treatment.
The Value of Treatment
Behavioral Health providers have de-valued the outcomes and significance of treatment by accepting lower reimbursements and agreeing to static reimbursement strategies.
In the dawn of healthcare reform, payors are recognizing the billions of dollars spent on behavioral health every year. Psychotropic medicines are usually one of the top medication spends for health plans every quarter. The effectiveness of hospitalization, outpatient treatment and, psychological testing are constantly in question by payors.
The Mental Health Parity Act has not served providers at the same level as it is serving patients. In the dawn of data analytical driven healthcare reform, BH providers are subjected to the same analysis as medical providers. Many providers challenge the measurement methodologies being applied to determine the effectiveness of treatment. Regardless, soon pay-for-performance relative to quality and outcome measures will be commonplace within the behavioral health industry.
Whether the BH provider community agrees or not, the payors have more data on treatment than any academic institution. The data analytic capabilities of multi-billion dollar payors will drive how care is delivered and reimbursed.
Providers that embrace outcome measures and pay-for-performance will have significant opportunities. Provider organizations have the ability to reclaim recognition for the significance and value of behavioral health treatment.
Outcome Measurement = Better Outcomes
Meta-analysis indicate that individual doctors and clinicians are the key to the variance of behavioral health outcomes. The past decade of research supports that the routine measurement of outcomes leads to improved outcomes, especially for patients identified to be at the greatest risks!
Doctors and clinicians that measure the outcomes of their patients, improve. Outcome informed doctors and clinicians recognize the importance of clinical skill in providing effective treatment. These providers support the desire to improve outcomes by actively evaluating themselves and applying the feedback to the treatment.
"Providers interested in measuring the outcomes of their patients are better providers."
Reimbursement and Outcomes
In the future, providers will receive reimbursement for collecting data and achieving established outcomes measures.
In network provider fee-for-service will be connected to outcomes measurement. Fee-for-service fee schedules will be adjusted to reflect three types of three or four types of providers.
- Providers not measuring outcomes will receive a relatively low standard fee schedule.
- Providers measuring outcomes will be provided a higher fee schedule or bonus over the standard fee schedule.
- Providers maintaining statistically significant outcome measures will receive an even higher reimbursement.
- Provider groups or integrated behavioral and medical groups that maintain statistically significant outcome measures may receive an even higher reimbursement.
Out of network providers will receive lower reimbursement than the in-network providers on the standard fee schedule. Out of network usual and customary or maximum allowable fees will be based on a percentage of the already low standard fee schedule.
Next Steps
There are many organizations that can help your organization develop and implement an outcome measurement strategy and a process that will bring value to your patients/members and your organization.
Sean B. Jones, MS, MBA, LPC, SAC, CEAP
Consultant
Consultant
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