When it comes to value-based care, there is no one size fits all approach.
In general, the goal is to improve patient outcomes while reducing the cost of care. But there are a number of ways to do that, so agreements often look different from state to state and payer to payer.
However, there are some universal strategies behavioral health providers can deploy to set themselves up for success in value-based care models. Stakeholders say it comes down to data, partnerships and practice.
The need for data in value-based care is obvious: Providers must track clinical and financial performance to determine whether they’re saving money and improving outcomes. But beyond existing, that data must be functional, especially if providers want to get the most bang for their buck, according to Kristina Colligan, product director at NextStep Solutions.
Based in Auburn Hills, Michigan, NextStep develops EHR technology for behavioral health care providers. Colligan said EHRs can make or break value-based models.
“Your EHR has to remove that admin burden, you have to seamlessly share data … , and you have to have automatic document exchange,” Colligan told Behavioral Health Business. “And if you can’t do that in an electronic way, you’re never going to be able to capture the information needed to get the highest tier of your value-based payment.”
On top of that, the more metrics a provider can track and convey, the better. Just ask Kevin Holst, the chief commercial officer at Groups Recover Together.
Founded in 2014, Groups Recover Together provides group-based medication-assisted treatment (MAT) for opioid use disorder (OUD). The Burlington, Massachusetts-based organization has more than 70 locations across 10 states — and over 70 value-based contracts with individual health plans in the commercial, Medicaid and Medicare spaces.
His best advice to providers hoping to succeed in value-based agreements is to follow the data and lean into offerings that address barriers to care.
“We are a highly metrics-driven business,” Holst told BHB. “We measure everything, we engage with our members through NPS scores on a routine basis. More than anything, the unfair advantage of our deployment model is the fact that we have more at-bats with this member population.”
Groups Recover Together sees its membership population weekly, which gives the provider more time to build trust and impact social factors that contribute to patient success. In addition to meeting with their counselor and group once a week, patients also get access to care navigation and peer recovery services.
Care navigators can help patients with everything from transportation and housing to food security and other social determinants of health, which wouldn’t be fiscally possible in a fee-for-service model.
As a result, 65% to 75% of Groups Recover Together members are still in treatment at month six, Holst said, versus 25% to 30% in traditional MAT. Additionally, Holst said the company gets abstinence rates as high as 90% across its patient population, versus about 20% in traditional MAT models.
Building the right VBC model
When it comes to payment, Groups Recover Together is held accountable for the bundled rate that it’s paid for driving key metrics for its members. But that model may not be right for everyone.
For example, Corbin Petro, CEO and co-founder of Eleanor Health, said she isn’t necessarily a fan of bundled payments in behavioral health. While bundled payments can work well for treatments that have a distinct beginning and end, they’re not best suited for chronic conditions, such as SUD, she said.
“When we think about how we try to partner with payers, it’s really on a longitudinal payment construct that pays us for our ability to engage, treat, get high quality outcomes and reduce the total cost of care for patients,” Petro told Behavioral Health Business.
With locations in six states, Eleanor Health provides comprehensive SUD treatment built around value-based care. That means the company addresses all sorts of co-occurring psychiatric and physical health conditions, in addition to SUD itself. Plus, it addresses factors such as transportation, housing, food insecurity and other social determinants of health.
To build successful value-based care agreements with payers, Petro advised providers to make sure evidence and holistic care are key parts of the model.
“The most important thing is to get aligned around the right set of outcomes and use the data and the evidence to do that,” she said.
Meanwhile, Lili Brillstein — CEO of BCollaborative, an advisory company that helps stakeholders move from fee-for-service to value-based care models — stressed the importance of making sure agreements are mutually beneficial for providers and payers. But before jumping into anything too intricate, she advised providers to start by taking things slow.
“I never advocate for shifting risk as quickly as possible,” Brillstein said. “I advocate for being in a simulator for a period of time — meaning a no risk model — where there’s plenty of opportunity to learn together, [providers] still get paid fee for service and they have an opportunity to earn additional money if they meet the metrics that you collectively agreed to.”
Additional reporting from Kyle Coward
