Challenges to the Biden-era parity rule, reductions to key behavioral health-focused agencies and looming Medicaid cuts are changing the game for how behavioral health providers operate.

Still, the preventative care push coming from the top is building a new race for behavioral health professionals to run, experts told Behavioral Health Business during a March VALUE event.

“Whether the funding comes or not, is going to be difficult, but it’s going to be a race to really show that value,” Peter Delia, manager of federal policy for the National Council for Mental Wellbeing, said. “If that [value is] there, I think the administration is going to want to pick up on something that can be objectively shown to provide value.”

The National Council for Mental Wellbeing is a Washington, D.C.-based nonprofit that serves as a network for providers in the behavioral health industry to access resources, advocacy tools and collaboration opportunities for mental health and substance use treatment.

Demonstrating value to prove to payers the impact of care outcomes has been a longstanding challenge for the behavioral health industry at large because physical care outcomes look much different and are historically easier to measure than mental health ones.

As the regulatory landscape continues to alter, running the race to prove value will require a different set of shoes to move toward that change.

“Let’s start innovating. There are models out there today in the outpatient space that I think are ripe for value-based contracting for opportunities to cut down on emergency rooms. I think there’s a lot of opportunity for value-based contracts,” Chris Santarsiero, vice president of government affairs at Connections Health Solutions, said.

Connections Health Solutions is a Phoenix, Arizona-based mental health service provider that specializes in crisis stabilization and enrollment in outpatient services. Its operations span five states.

Models like the Arizona Health Care Cost Containment System’s (AHCCCS) managed care program that is patient-centered and looks at providing care in the most cost-effective, value-based way, Santarsiero said, are “becoming a real opportunity for payers, – state payers, local payers and private payers – to really innovate and offer that nexus point of access to care for psychiatric and treatment and health and recovery.”

What’s on the menu

Rocky regulatory changes are not new to behavioral health, nor is the climb to push for party and widespread adoption of value-based models. So, having a seat at the table and an ear to the ground is critical to successfully navigating the changing dynamics.

“If you’re not at the table, you’re probably being served on the menu,” Santarsiero said. “We’ve gone through these stormy times before, and it’s incumbent. We built the playbook as a healthcare community to not just be behavioral health providers, outpatient providers or inpatient providers. We really need to be banding together with the hospitals and with the nursing homes, because at the end of the day, in terms of behavioral health, Medicaid is the largest payer, so we’re all concerned.”

Models like crisis stabilization centers and Certified Community Behavioral Health Clinics (CCBHC) have demonstrated measurable cost savings and improved patient outcomes. The Safer Communities Act of 2022 established an aim to increase access to CCBHCs to expand services and reach nationwide. While it is time-limited and a demonstration program, it established a model that states and providers can adopt to move toward value-based care, even if the demonstration ends. 

The National Council for Mental Wellbeing is currently working on legislation to further strengthen this model and make it more sustainable going forward, Delia confirmed.

The rise of telehealth and artificial intelligence in care has also increased an industry-wide focus on preventative care, peer support models and new ways to measure metrics to prove value. Despite regulatory headwinds, this is opening up opportunities for new value-based care models providers can adopt, Daniel Patten, a partner with health care-focused law firm Holland & Knight, explained.

“I’m seeing a shift culturally and from an enforcement standpoint. It’s much more open. Instead of the presumption that you’re doing it incorrectly, there’s almost more of a presumption that you’re trying to find better value,” Patten said. “We’re seeing a little bit more flexibility on the enforcement side. I’m seeing an incredible [amount of] interest in new models and a push for new models that are still clinically appropriate and safe. I’ve seen more development of this on the mental health side in the last three years than in the decade before that.”

Moving the needle

Rapid shifts from left to right and somewhere in between are likely to continue in the regulatory space. However, forging partnerships with peers and making space for advocacy conversations is how providers can move the needle toward value-based arrangements.

From an enforcement perspective, changing the acceptance of how services are billed and reviewed could make way for improvements in these models, too.

“I think more acceptance of preventative codes early, instead of treatment when someone needs to intervene, is key,” Patten said. “We’re seeing more acceptance towards the prevention side. I think more acceptance of that and less review from enforcement agencies if you’re just trying to bill more. When a lot of times those services are crucial.”

Working to eliminate barriers and elevate peers to a status where payers recognize them is one step in the right direction toward addressing care and getting positive outcomes, Santarsiero and Delia agreed.

“There’s a recognition that the status quo simply is not getting it done,” Santarsiero said. “And I think that’s a good testament to the need. There’s a lot of opportunity still, despite all the noise and the threats right now. There’s a lot of opportunity to continue to advance this movement. And I do believe value-based arrangements are key to that because the metrics are there and I think the outcomes will prove themselves.”