Behavioral health is a complex and costly category of care. This is true when working with any behavioral and mental health patients, but especially those with intellectual and developmental disabilities (IDDs), such as autism. In between delivering exceptional member experiences and staying in compliance with evolving laws and regulations, simply keeping up with the rapid pace of change in behavioral health care delivery is a difficult task.

Yet keeping up is critical, as delivering behavioral health services is more important than ever. This article, adapted from a new white paper from Catalight — which provides access to innovative, individualized care services, clinical research and advocacy — presents four trends shaping payer opportunity, and shows how expanding access to care can improve wellbeing and outcomes for all.

The rise of value-based care in behavioral health

While behavioral health has been slow to move toward value-based compensation, the landscape is now evolving — and fast.

Trends toward value-based care (VBC) models in behavioral health are emerging due to greater coordination between payers and providers, allowing the standardization of measurable and meaningful outcomes. States and organizations are testing VBC payment models that could be applied to behavioral health, including capitation, pay-for-performance and shared risk models.

The integration of behavioral health services into holistic care represents a great opportunity to change how care will be delivered.

Yet obstacles to rapid, widespread adoption remain. The lack of an industry standard defining which specific metrics translate to value and how to attribute costs creates a major challenge. Without historical data comparable to other conditions, payers struggle to precisely identify the true costs of behavioral health care.

As such, they have difficulty proposing sustainable solutions.

In addition, providers may struggle operationally when moving to a value-based model, as they might need to invest in systems to better capture data for establishing baselines and measuring outcomes. This leads to eight key challenges to adoption — factors that have, historically, negatively impacted behavioral health’s evolution to VBC:

• Fragmentation of the health care system
• Health insurance carve-outs
• Weak enforcement of mental health parity laws
• Lack of data and standards around outcomes
• Low reimbursement rates
• Lack of widespread adoption of systems to capture standardized digital records
• Barriers to consumer access of behavioral health services
• Lack of historical data showing how behavioral health outcomes reduce overall health costs

New behavioral health laws — and better enforcement of existing ones

While the Mental Health Parity Act (MHPA) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) have long established the legislative basis for behavioral health parity in health care, the enforcement of these laws has been inconsistent.

That is starting to change.

Federal and state government entities have upped the ante on enforcement, thus giving teeth to the 2021 Consolidated Appropriations Act, the law that requires group health plans to provide analysis of non-quantitative treatment limitations (NQTL) to ensure parity with medical and surgical benefits.

By simply enforcing existing parity laws, today’s elected officials are showing that comprehensive compliance and quality programs are a high priority. As a result of these changes, behavioral health providers and their administrators need to increase the quality of their care and focus more on documenting and reporting.

The ability to meet parity regulations and better coordinate the delivery of care within integrated health care organizations represents a mission-critical challenge with significant financial and legal repercussions for payers.

Meanwhile, at the state level, legislation changes and enforcement efforts point to an increased focus on mental health parity. A 2022 study by The Council of State Governments found that at least 16 states have passed recent legislation or acted on enforcement and compliance efforts. The states addressing parity gaps are:

• Arizona
• California
• Colorado
• Connecticut
• Delaware
• Georgia
• Illinois
• Maine
• Massachusetts
• New Hampshire
• New York
• Oregon
• Pennsylvania
• Rhode Island
• Texas
• Washington

Embracing innovation to fill care gaps

Access to health care was a challenge before 2020, but the COVID-19 pandemic made everything harder, leaving millions of people struggling through constrained services. This was especially acute in behavioral health care, a field already historically hampered by a shortage of licensed clinicians and registered practitioners, a lack of effective case management, under or over-diagnosing vulnerable populations and limitations to health care data management.

The effects have been lasting. In a 2022 Gallup and West Health poll, 75% of Americans graded health care affordability a ‘D’ or ‘F.’

The need for transformation in behavioral health represents an opportunity for innovation that could dramatically impact access to person-centered care focused on meaningful outcomes. Catalight, for instance, offers advanced modalities of care, such as Parent-Led ABA, a parent-mediated approach where parents provide direct treatment with the support of a Board Certified Behavior Analyst^® (BCBA^®) or a Board Certified Assistant Behavior Analyst^® (BCaBA^®). 

Organizations that can develop new treatments to meet access issues while consistently delivering high-quality, affordable care will be primed to thrive in this new era.

Outsourcing for scale: how partners make perfect

The need — and demand — for behavioral health services grew rapidly during COVID.

Nowhere was that growth more evident than in a recent survey by AHIP which revealed that over the last three years, 89% of commercial health plans are actively growing their behavioral health networks.

That growth brings challenges of scale, such as finding qualified providers to expand existing networks. For providers of autism care, a shortage of trained clinicians diminishes their ability to meet increasing demand. High turnover rates then lead to inconsistency in services and severely disrupt an organization’s ability to expand care.

As such, this unprecedented demand is leading more and more payers to consider augmenting their providers and their internal provider management capability or outsourcing it all together to experienced network optimizers. These network optimizers drive efficiency by managing key issues — scale, access, timeliness, quality and data — and share expensive administrative costs with the payer.

This article is sponsored by Catalight and is excerpted from their white paper “Top Trends in Behavioral Health for Payers: 7 insights that are shaping access, quality and value.” To download the full report for free, click here.

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Sources:

• Kirby, Jessica, and Slone, Sean. “Mental Health Insurance Parity: State Legislative and Enforcement Activities.” CSG, April 28, 2022
• AHIP. “New Survey Shows Strong Action by Health Insurance Providers to Growing Mental Health Care Demands.” Aug. 4, 2022
• 2022 Gallup and West Health poll on health care affordability