Peer Workers, Better Outcome Measures Key to Successful Value-Based Care in Behavioral Health

Behavioral health proponents often tout value-based care as an efficient way for providers to deliver better services, giving them the chance to be paid based on the quality outcomes they produce for patients rather than the historically low fee-for-services reimbursement rates they typically receive.

The payment model has picked up steam in recent years, as new federal rules have modernized statutes and laws in an attempt to reduce obstacles to value-based payment and care coordination. Plus, the coronavirus has accelerated things further, reinforcing behavioral health’s role in improving overall health outcomes and lowering total care costs.

But not all value-based care models and adoption practices are created equal.


“If we really want to change the system to be focused more on value [and] to incentivize those little touch points that make such a difference in care that aren’t necessarily face-to-face, we’ve got to move toward value-based payment, toward more of a capitated or global payment rate and toward more of a population health approach,” said Katherine Knutson, the senior vice president at United Health Group and the CEO of United Health’s behavioral health arm, Optum Behavioral Care.

Knutson weighed in on the topic during a recent webinar hosted by the health care professional organization RISE. During the virtual event, panelists talked about strategies for creating a behavioral health care model driven by health outcomes.

One strategy that Knutson — who is an adult and child psychiatrist by training — talked up during the discussion was the use of peer workers, who are professionals that have personal experience with behavioral health issues and who provide mentorship and advocacy to others going through similar experiences.


Peers are a growing workforce in behavioral health, with an estimated 30,000 or so workers employed nationwide. Additionally, over three-quarters of states reimburse peer services through Medicaid, but not all payers are as progressive.

Still, she stressed their importance to providers in the space.

“These are people with lived experience [dealing] with substance use and mental health,” Knutson said. “Bring in peers to help align with people [and meet] them in the community. These are … things that we can do to help improve the access and … the quality of care ultimately leading to better health outcomes and costs.”

Various published studies have made the case for the use of peers in behavioral health care, and Knutson noted that peer workers could be a novel way to assist health care systems burdened by limited resources. One reason for the lack of resources and personnel in behavioral health is the low reimbursement rates providers typically are paid on a fee-for-services basis.

“I would rather go to… a global payment model where we say, ‘This is the amount of money [providers] have … to deliver all the care that’s needed,’” Knutson said. “How can a provider deliver these services in a way to where they’re maximizing the resources and maximizing those health outcomes? That’s when you see those investments in peer support.”

Knutson also noted that the behavioral health care industry, in its move toward value-based care, needs to develop better measurement tools for patient outcomes.

“Right now, the true health outcome measures in behavioral health are the person-reported health outcomes [and] the symptom rating scales — so like the PHQ-9 for depression, for example — but that’s really limited,” she said. “You’re asking somebody to think back over the last two to four weeks and … measure their symptoms. If we had ways to measure outcomes in real time and symptoms in real time — even through passive devices — it would be a true game changer.”

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