What is Value-Based Care?
The concept of ‘Value-Based Care’ was coined by Michael E. Porter and Elizabeth Olmsted Teisberg in Redefining Health Care: Creating Value-Based Competition on Results. Traditionally health care has been fee-for-service, where a patient or insurer pays for a service. However, in a value-based care model, “Value is defined as the outcomes that matter to patients and the costs to achieve those outcomes,” according to Harvard Business School’s Institute of Strategy & Competitiveness.
Caron Treatment Centers
Caron was founded in 1957 and headquartered in Wernersville, Pennsylvania. Caron is a not-for-profit substance use disorder (SUD) treatment provider.
In 2017, Caron entered into a three-year pilot with Independence Blue Cross (IBC) using a value-based payment model. As part of this risk-bearing agreement, if a patient needed to be readmitted within three months of discharge, Caron would offer the follow-up treatment for free.
In 2019, less than 6% of the 71 IBC beneficiaries treated by Caron under the agreement relapsed within 90 days. Comparatively, readmission rates for other providers in IBC’s network ranged from 12% to 26%.
When Brad Sorte became CEO in 2021, he prioritized value-based care for addiction treatment for the future.
“Value-based care puts the onus on the provider to raise their standard of care,” Sorte said. “But the long-term effect of raising the standard of care will eventually be better outcomes for the patient, lower costs for the payer, and hopefully, better reimbursement.”
Oceans Healthcare
Founded in 2004, Oceans Healthcare, headquartered in Plano, Texas, initially provided behavioral healthcare to older adults and seniors. As demand for behavioral healthcare grew, so did Oceans’ offerings. Oceans operates 33 locations, 23 hospitals, and 2,000 employees, treating 24,000 patients annually.
In 2019 Oceans adopted the PHQ-9 as a measurement of an outcome as it began an organization-wide quality improvement initiative. Melynda Boothe, Executive Vice President of Process Improvement and Outcomes for Oceans, said PHQ-9 assessments could be ideal for providers interested in value-based care because they help constantly assess service quality.
Oceans opened locations in Texas, Louisiana, and Oklahoma in 2021. It kicked off 2022 with a new investment from Webster Equity Partners. Value-based care is top of mind at Oceans.
“We remain dedicated to quality inpatient care and are among the industry’s leaders in defining quality metrics,” Stuart Archer, CEO of Oceans Healthcare, said.
Beacon Health Options
Founded in 1983 and acquired by Anthem in 2020, Beacon works with employers, health plans, and government agencies to provide mental health, emotional wellness, and substance use disorder (SUD) treatment services to over 40 million customers across all 50 states. Post acquisition Beacon Health Options wasted no time hiring former Talkspace CMO Neil Leibowitz as its Chief Medical Officer and former Aetna alum Glenn Macfarlane as its Chief Clinical Officer.
Both Leibowitz and Macfarlane are aligned with value-based care.
“I would like within the next three-plus years to have all our spend linked to some sort of value-based arrangement. That’s the goal I’ve set with my team, and I believe it’s achievable,” Macfarlane told Behavioral Health Business.
During the Behavioral Health Business VALUE conference, Leibowitz said that standardized screening assessments — such as the GAD-7 for anxiety and the PHQ-9 — don’t present actual outcomes and have limited utility in the context of value-based care.
“If we go back to the evidence, what we do know about behavioral health and we know that works — I want to know about empathy; empathy is the main driver,” Leibowitz said of a measure that he knows Beacon Health Options will look at in terms of assessing value-based care.
Headspace Health
Founded in 2010, Headspace became Headspace Health after merging with Ginger in 2021. With a partnership with Solera Health, an acquisition of Sayana Inc, two c-suite hires, and a nod from MIT, headspace has a comparable impact on in-person therapy. Headspace is on its way to becoming one of the largest digital mental health providers.
The company’s deal with Cigna is a prime example of its plans for an integrated future. The partnership could also provide insights into digital behavioral health care, which could pave the way for value-based care moving forward.
“To me, it feels like we’re in very early stages. We’re a year into our partnership with Cigna; we’re starting to study the clinical outcomes and understand what’s working and what’s not.” Headspace Health Senior Vice President of Partnerships Katie DiPerna told Behavioral Health Business
Hopebridge
Founded in 2005, Indianapolis-based Hopebridge is one of the largest autism therapy networks in the country. Hopebridge started in 2021 with a new VP of clinical services, opening six locations in Arizona and committed to thirty further applied behavioral analysis (ABA) therapy centers. Earlier this year, Hopebridge announced that it plans to open up to 40 new clinics nationwide in 2022.
“You have to make sure that as you’re serving more communities and scaling your business across more communities, that the experience, the clinical quality, and the experience for both of your team members and the child and the family is the same,” Hopebridge CEO Dennis May told Behavioral Health Business.
With two more c-suite hires, Hopebridge executives are tasked with driving better outcomes and value-based care.
“I am confident that our investments in clinical excellence and a strong clinical leadership team will not only elevate the quality of care for Hopebridge but will create advancements for the entire industry as a whole.” Hopebridge CEO Dennis May said in a press release.
