Health care’s shift from fee-for-service reimbursement to value-based care has been slow. But finally, the coronavirus is accelerating the industry’s movement in that direction, which bodes well for behavioral health providers, who are known for the long-term outcomes they deliver.
Even health insurance giants like Anthem (NYSE: ANTM) are jumping on board: Earlier this month, Eric Bailly, Anthem’s business solutions director and head of substance use disorder (SUD) strategy said he expected to see “very few organizations that are still really heavily weighted on the fee-for-service models” by 2026.
The latest company to join the charge is Spring Health, a behavioral health benefits company that recently rolled out a new value-based care model to reimburse providers in its network.
It dubs the system, called Candela, as the industry’s first pay-for-performance framework based on real clinical outcomes.
Headquartered in New York City, Spring Health helps employers connect their workers to behavioral health resources. Its comprehensive solution can direct employees to any type or level of care, from self-guided digital exercises and employee assistance program (EAP) services to coaching, therapy and prescriptions. Those services are delivered by vetted behavioral health providers in Spring Health’s network.
The company, which was founded in 2016, uses a proprietary mix of technology and human touch to match people with the right treatment, taking the guess-work out of mental health care in an effort to get people better care faster.
Spring Health’s new value-based payment model, which it beta tested throughout 2020, is just another extension of that mission, according to Dan Harrah, the company’s national director of clinical partnerships.
“We want to ensure that we’re identifying the actual issues that we need to work on and that we’re using evidence-based treatment and measurement-based care to ensure that people are getting better faster,” Harrah told Behavioral Health Business. “It’s a way not only to reward our providers for doing better … but it’s also a way to ensure that our whole network is living up to the standards that we set.”
Candela works by tracking providers’ performance in an internal dashboard, where Spring Health keeps track of a variety of clinical and operational metrics. Some examples include severity of depression or anxiety symptoms; length of time it takes to move members into remission; member satisfaction; and completion of patient notes.
Candela providers also receive monthly reports summarizing the volume of their work, as well as their percentile rank and details on how their scores match up against others in the network. The metrics and suggestions provided in the report can then be used to help inform providers’ practices.
After a certain period of time, Spring Health rewards its top providers — individual clinicians, not organizations — with cash bonuses on top of their normal payments. Meanwhile, it coaches providers who don’t perform as well on how to improve.
Spring Health provider Mark Tovar, a licensed professional counselor (LPC) and supervisor of LPC interns, said those financial incentives have the potential to make a world of difference in behavioral health, which is known for its low reimbursement rates, high turnover and pervasive workforce shortages.
“In the human service field, the adage of ‘do more, expect less’ is killing our profession,” Tovar told BHB in an email. “I think this is an amazing benefit that Spring Health provides its providers, and my goal is to increase my positive outcomes, not for the money, but because it is a nice benefit from Spring Health and makes me feel like I am part of a group that rewards excellence.”
Tovar has been using Candela for about two months, and he received his first cash bonus in February. Tovar said that’s his first time in 20 years to ever receive any sort of incentive for measured outcomes.
While the bonuses are a plus for providers, they ultimately benefit Spring Health and the employers who use it, too. It’s the perfect win-win, Harrah said.
“We wanted to align our incentives so that when our members get better faster, our providers do better financially,” he said. “And what that also means is that our partners who purchase Spring Health also get a benefit out of it: It means that their population is recovering faster.”
Harrah called Candela the “most detailed value-based model that exists in outpatient behavioral health care.”
While it’s still early days for the pay-for-performance system, Harrah said the company is all in on the concept and the impact it can make on behavioral health care delivery industry-wide.
“We want to improve behavioral health service delivery in this country,” Harrah said. “It’s absolutely a part of our DNA [to] show the value of the care that we’re providing, and that is absolutely what we’re going to be doing going forward.”