The gradual move in behavioral health toward value-based care has shone a bright light on patient outcomes. With government and commercial insurers pivoting away from the traditional fee-for-service payment model, a number of providers are also embracing the arrangement.
As some behavioral health executives tell it, value-based care is an effective way to keep many providers honest when it comes to outcomes. But as far as defining standards to measure outcomes in a value-based system, some providers are hoping to get more of a say-so in the process than they feel they currently have.
Such were the sentiments shared by participants on a panel during the Behavioral Health Business INVEST Conference, held Oct. 14 in Chicago.
“In terms of the investments that we’re making, it really is about the outcomes data,” Vertava Health Chief Development Officer Tom Viscelli explained during the panel, where participants discussed the outlook for behavioral health heading into 2022. “Behavioral health is far behind the physical health care space in trying to track outcomes.”
Vertava Health is a Nashville, Tennessee-based provider of substance use disorder treatment (SUD) and mental health conditions, operating across five states. Viscelli told attendees that Vertava Health is a firm believer in value-based care and that the provider has been making substantial investments with its technological capacities in order to better track patient outcomes.
“We, as an industry, have not always done a good job adopting new technology,” Viscelli said. “We certainly have not done a good job with data with outcomes tracking. The more that dollars are coming in to invest in those kinds of tools, and the more tools that become available to us as providers, the more that we can track outcomes and keep a live view of our patients.”
In addition to patients, Viscelli said that value-based care benefits providers like Vertava Health in that by demonstrating effective patient outcomes, they can negotiate for better reimbursement rates from payers. Viscelli says that Vertava’s data network and overall technological capacities — which he described as top notch — allow the provider to do just that.
“We’re partnered with a data provider who can say, ‘Here’s where you stack up compared to the rest of the industry, and you’re in the 90th percentile of patient outcomes.’” Viscelli said. “And that’s a really powerful message to bring to the payers and say, ‘This is why you should share some of the benefits with us.’”
Oceans Healthcare CEO Stuart Archer also participated on the panel and discussed the industry’s increased emphasis on outcomes through value-based care. When it comes to defining what constitutes effective outcomes, Archer said that it is critical that providers be given significant input into what such measures mean.
“We’ve defined good outcomes too many times by what the payers think,” Archer commented.
Archer said that value-based care is an important service component for Plano, Texas-based Oceans, which operates more than 40 locations across Texas, Louisiana and Mississippi. Additionally, Oceans works with over 200 nursing homes nationwide to provide post-discharge services to patients.
Executives like Archer acknowledge that establishing broad consensus on effective outcomes is one of the more challenging tasks for payers and providers across the behavioral health spectrum — even as many wholeheartedly support the move to value-based care.
“There’s a little trap here if we’re not careful, because our patients are different,” Archer said. “A good outcome may be that this patient is safely maintained in a residential setting for the rest of their life, or, maybe that this person is able to return to work. It gets really complex in behavioral health.”
Archer said that as providers like Oceans are ultimately given more input into the creation of such benchmarks, it is important for them to not take such responsibility lightly.
“I think that as much as given, much is expected,” he said. “As we advocate and want a bigger seat at the table, we’re going to have to accept and get ready for higher expectations, higher outcome quality and higher transparency.”
Also chiming in on the subject was Rob Marsh, who is the senior vice president and chief operating officer of Kindred Behavioral Health Services. Marsh agreed with Archer that when it comes to defining effective outcomes, providers and payers are in for a bit of a long haul.
“There’s this ongoing struggle that our industry has with the payers, and helping them understand that for one autistic kid, tying the shoe might be a huge goal that’s been met,” he said. “For another autistic kid, maybe they were able to attend school for a full day.”
Like Marsh, he said it is crucial that providers be given more of a voice in the development of outcome measurements, as the industry moves to value-based care.
“What we’re trying to do is educate the payers,” he said. “We’re trying to control the narrative versus the payer coming to us and saying, ‘Hey, ‘We’re looking for X, Y and Z.’ We’re the ones going to them saying, ‘Let’s look at falls, let’s look at suicide attempts, let’s look at these other major areas.’”
Judging his own experiences, Marsh believes that payers are actually willing to engage providers on the subject.
“I would say that our conversations have been well received,” he said. “Payers are very hungry for that type of tracking of data and different outcomes than they’re tracking right now.”
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