Traditional fee-for-service reimbursement arrangements may be leading to increased costs for payers. 

That’s according to new findings from value-based care provider Cityblock Health, published in NEJM Catalyst. The study found that Medicaid and dually eligible patients enrolled in Cityblock’s behavioral health program exhibited an 11.5% decrease in total cost of care and a 19.7% decrease in inpatient treatment utilization compared to patients not enrolled in the program. 

“Ultimately, these findings are important because they demonstrate the effectiveness of integrating medical, behavioral, substance use disorder, and social care in a value-based model,” Ruby Mehta, head of behavioral health at Cityblock, told Behavioral Health Business. “When I see the results, I’m encouraged and optimistic about the impact we can have on some of the most vulnerable Medicaid members.”

Researchers analyzed data from 123 Cityblock members from its pilot program in Washington, D.C. beginning in April 2022. On average, patients were enrolled in the program for about 10 months and received an average of 2.3 connections with care team staff per month as well as another two care planning activities per month.

Patient engagement did drop off over time, and researchers noted they want to improve continued engagement with members in the future.

Brooklyn, New York-based Cityblock provides behavioral health, clinical and social care to over 100,000 Medicaid and Medicare-Medicaid dually eligible beneficiaries through virtual, in-home and community-based treatment programs. The provider operates in New York, Massachusetts, North Carolina, Ohio, Indiana, Illinois and Florida.

The Cityblock program, called the Advanced Behavioral Health (ABH) program, is designed to increase access to behavioral health interventions including injectable antipsychotics, medications for opioid use disorder (MOUD), contingency management, care coordination and social care navigation. Cityblock’s highest-risk patients are eligible for the ABH program.

Every ABH member is assigned a care team consisting of a medical provider and a nurse care manager. A patient’s care team coordinates with external providers to set up appointments and with patients’ health plans to accomplish tasks including ordering medical equipment and researching food pantries.

These tasks may not be reimbursed, or be inadequately reimbursed, by Medicaid under a traditional fee-for-service payment model, creating a significant care gap, according to Mehta.

“Value-based payment models allow for more flexibility in the services we can provide from medical to psychiatric care, in-home services, community health workers and more that traditional fee-for-service models don’t typically offer,” Mehta said.

Research like this study could help validate the importance of value-based care systems that improve access to behavioral health care for Medicaid beneficiaries.

Since the initial pilot program, Cityblock has expanded the ABH program to all seven of its markets.

This isn’t the first study to demonstrate the potential benefits of value-based care. In 2023, a JAMA study found that value-based payment reform may decrease mental health emergency room visits.