Value Based Care - It's coming!
I have a big concern about value based care and it's not the concept nor the implementation. I am very concerned that some of our colleagues in the clinical mental health profession may not be aware of value based care and may not know the potential ramifications.
From Forbes - Value-Based Mental Health May Be 'Gold' For Insurers
News that one of the nation’s largest health insurance companies is pursuing an evidence-based approach to substance abuse treatment and opioid addiction could potentially speed up the slow march away from fee-for-service mental health treatment.
But Cigna CI -2.29% and other health insurers that escalate their shift to value-based payments could reap a potential bonanza by reimbursing psychiatrists and other mental health providers based on how they improve the care of their patients, mental health advocates
Just ask Patrick Kennedy, who advocates for improving the nation’s mental healthcare system by moving to a value-based system, which measures and rewards providers based on how well they care for patients, treating them more holistically.
I presented at a state conference last week and asked the audience attendees who worked in private practice and who used outcome measures. I was asking about simple outcomes measures, something simple like a Likert scale. Not one licensed clinical MH counselor raised their hand - NOT ONE. I'm concerned. How do we measure progress? Don't worry too much - we are not alone. It's not just our profession. According to a recent 2016 white paper by Beacon Health Options, only 18 percent of psychiatrists and 11 percent of psychologists in the U.S. routinely administer symptom rating scales to patients to monitor improvement. Then I asked the conference attendees if they developed their treatment plans using SMART goals in a person centered process. A few people raised their hands. I asked how did they tracked patient progress and how did they document the "progress or lack of progress" towards goals. One person shouted out that they "wrote down what the patient said". I'll take that because at least we have a start here.
A good quick read about the imminent future and what we clinical MH counselors need to know about integrated care can be found in Beacon Health's 2016 White Paper - INTEGRATION - A 2016 BEACON HEALTH OPTIONS WHITE PAPER
The conclusion of the Beacon white paper indicates: Successful integration calls for all practitioners, including behavioral health and primary care, to cease working in isolation. It demands shared accountability among all involved parties—payers, physical and mental health providers, and broader system stakeholders. This is not business as usual. None of that can be achieved without a system overhaul. Behavioral health—as a significant driver of total health care costs—cannot get lost in the mix. Therefore, consistent with the evidence base about what integration is and isn’t, we propose advancing a coordinated integration strategy in partnership with all industry stakeholders and the people we serve. The collaborative care model provides a launching pad for doing so.
Our profession, clinical mental health counselors, needs to do better. Knowing about Evidenced Practices is a start but implementing them and using measurement tools to bring credence to our work and substantiate the progress is critical. We need to become more informed and educated about the behavioral healthcare industry and posture ourselves for changes that are coming. Many private outpatient clinical mental health counselors operate their practice as "Fee-for-service" through insurance reimbursement. If they are not informed, aware nor prepared to adapt to potential changes, how will they survive?