What Does Value-Based Purchasing Mean for Behavioral Health Services? 2:20 PM – 3:20 PM Steering Toward Success - Achieving Value in Whole Person Care September 25 and October 26, 2017

The Healthier Washington Practice Transformation Support Hub

What Does Value-Based Purchasing Mean for Behavioral

Health Services?

Nina Marshall Senior Director, Policy &

Practice Improvement National Council for Behavioral Health

• Learn about the basic components of value-based payment arrangements for behavioral health services being adopted nationally and to what extent these arrangements make up an individual providers’ revenue

• Understand which measures are best used to assess value and how to most effectively balance quality measures for medical/behavioral health services with other types of measured outcomes (e.g., housing, employment, etc.)

• Learn the core competencies necessary for behavioral health providers to be successful in value-based payment arrangements

Learning Objectives

Value-Based Payments: Incentive for Results

Fee For Service: Incentive for Volume

Service Payment

Service

Service

Payment

Payment

Metrics to track: • Unit of care • Volume

Quality

Cost Population

Metrics to track: • Clinical outcomes/best practices • Population and leading

indicators for risk • Total cost

$$

Federal Framework for Alternative Payment Models

Survey Says…

National Adoption

19.10%

2.70% 6.80% 5.40%

2.70%

1 2 3 4 5

PERC

ENT

OF

ORG

ANIZ

ATIO

NS

SURV

EYED

PERCENT OF ORGANIZATIONAL REVENUE FROM VALUE-BASED CONTRACTS

Behavioral Health & Social Services Adoption

OPEN MINDS 2016 Survey HCP LAN 2015 Survey

Value in Value-Based Payments

= Quality

Cost

Measurement

A perpetual question…

Follow Up After Hospitalization for Mental

Illness (31.5%)

Readmission Rates (15%)

Access (15%)

Others

In Real Life: The Top Three

Value-Based Payment Readiness

Patient- and Family-

Centered Care Design

Data-driven Quality

Improvement

Sustainable Business

Operations

Strategic and Effective Clinical Care

Value-based Payments requires… Population Health Management which requires… Risk Stratification which requires… Care Pathways that are administratively + clinically sound.

Concepts that are not loosely linked but structurally contingent on one another.

• Improve quality and manage costs for, e.g.: – Clients with a recent hospitalization – Clients with co-occurring MH/PH,

e.g., clients with schizophrenia or bipolar and diabetes

• Have to manage to risk of outliers

– Overutilization – Underutilization – Other types of risk

Population Health Management

• Define the expectation (up next) • Find the outliers! • Traditionally “risk” definition:

– Suicidality • Today, also:

– Use of pain medication – Use of antipsychotic medications – Medication adherence – Recent or multiple

hospitalizations – Missed appointments

• Develop system for systematically tracking and monitoring for risk

Risk Stratification

• Define what is normal/expected easier to identify the outliers • Relieve dependency on individual decision-making • Administratively and clinically linked and sound • Start with common clinical profiles, e.g., major depressive disorder

Care Pathways

Combat this

Replace with

If a tree falls in the forest and no one collected the data,

it didn’t make a sound.

Contracting with a Payer

Or…

Value in Value-Based Payments

= Quality

Cost

Comments

Rick Weaver

CEO Comprehensive Healthcare

What Does Value-Based Purchasing Mean for Behavioral Health Services?

Nina Marshall Senior Director, Policy & Practice Improvement National Council for Behavioral Health NinaM@thenationalcouncil.org Rick Weaver CEO Comprehensive Healthcare Rick.weaver@comphc.org

Questions?

Q & A

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.