Value-based care can enable personal relationships between behavioral health patients and providers in ways that fee-for-service models simply can’t.
These relationships can be essential for supporting people with comorbidities in their journeys to live healthier lives. One way to build such relationships is by caring for patients in their home and the community, while integrating wraparound services to treat the whole patient.
“I think we’re seeing the imperative that physical and behavioral health become integrated into primary care together,” Nicholas D’Addabbo, vice president of strategy at Innovive Health, said at the Behavioral Health Business VALUE conference. “The success of patients, especially those with substance use disorders (SUDs) or severe mental illness (SMI), needs both.”
Massachusetts-based Innovive provides in-home skilled nursing to individuals with SMI through partnerships with Medicaid and Accountable Care Organizations (ACOs).
Value-based care’s focus on preventative care and addressing social determinants of health also brings a new set of providers into the equation.
“Now we have to build a workforce to be able to do those things,” Dr. Michael Tang, head of behavioral health at Cityblock Health, said at VALUE. “It’s less about the specialist doctor, and it’s now much more about the community health worker, the social workers who are comfortable in integrated settings. And so that’s a really exciting part about value-based care.”
Cityblock Health is a value-based care provider for Medicaid and lower-income Medicare beneficiaries. The organization teams up with community-based groups and health plans to provide physical health care, behavioral health care and social services.
Care teams who go into a patient’s home or community can identify issues that can hinder not just behavioral health needs but also their physical health needs.
D’Addabbo gave the example of a patient with Type 2 diabetes and paranoid schizophrenia who has very few resources and essentially alienated their entire support team.
“So now they’ve got a group like WaySpring or Cityblock or Innovive who’s working with them to ensure that they remain medically and behaviorally stable,” D’Addabbo said.
Providers such as these have the ability to check on a patient’s social determinants of health. For example, care teams can look at what is in their fridge to each or if they are able to pay their electric bill. If a patient doesn’t have healthy food or a way to store their insulin, overall care will decrease.
A focus on engagement
Engagement is one of the biggest challenges for treating patients with SMI and physical health comorbidities. This is where peer specialists, community mental health workers and individuals with lived experience could change the game.
“I think we are seeing an expanded multidisciplinary treatment team now, … people who are focused more on engagement” Dr. Michael Frost, chief medical officer of Wayspring, said at VALUE.
However, the services of many of the staff members involved in engagement may not be reimbursable in a traditional fee-for-service model.
“We have found engagement is the necessary piece of the entire puzzle,” Frost said. “It doesn’t always have to be the highest-priced person in your workforce doing that, and it can be the person who is going to have the most contact.”
Nashville, Tennessee-based Wayspring is a value-based care organization that provides care to individuals with SUDs.
Conversations around including community care workers and peer specialists have been in the works for over 20 years. But without a clear reimbursement strategy, it was a hard sell.
At the end of the day these relationship-driven positions could help providers save money.
“Now, in a place like CityBlock, you can start to actuarially think about the value of high engagement through a community health worker,” Tang said. “That’s the beauty of a value-based care arrangement is it becomes less about who does this and who does that.”
Involving more community care workers in the care paradigm isn’t only beneficial for the patient. It could help alleviate staffing pressures.
The American Public Health Association reports that more than 6,600 mental health practitioners are needed to fill open vacancies.
“In today’s workforce environment, [it’s important] to make sure that you’ve got these multidisciplinary teams and everybody’s working to the top of their license,” D’Addabbo said. “If they’re a relationship manager, they are working to the top of their license on managing relationships with patients.”
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