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Value-Based Payment Models for Behavioral Health Providers

Value-based payment (VBP) models are a break from the volume-based, fee-for-service models that have long been the norm in U.S. healthcare. Under VBP, healthcare purchasers and payers hold providers accountable for healthcare quality and costs.

Many states and organizations are testing VBP models that could be applied to behavioral health, but have not yet chosen a standard for widespread use.

What are some models for value-based payments?

Valence Health (now Evolent Health) issued a white paper in 2013 that illustrated several potential VBP models that health providers could adopt. These include:

Pay for Performance, which ties financial incentives to measured performance
Bundled Payment/Episode of Care, which provides a single negotiated payment for all services delivered for a specified procedure or condition
Patient Centered Medical Home, which establishes a team of health professionals that work together to coordinate a patient’s care, particularly those with chronic or complicated conditions
Shared Savings, which rewards providers for reducing total healthcare spending on their patients below a level set by the payer, giving the provider a portion of the savings
Shared Risk, under which the provider must cover part of the costs if they do not meet savings targets
Capitation Models, under which a provider organization receives a set payment per patient for specified medical services, requiring the provider to take on all insurance risk for the covered patient and services
Provider-Sponsored Health Plans, under which a provider network assumes all financial risk for insuring that patient population and collects the insurance premium directly from employers or individuals

What value-based payment models are being implemented now?

The Affordable Care Act of 2010 instituted the Hospital Value-based Purchasing Program and Hospital Readmission Reduction Program. These initiatives reward acute-care hospitals with incentive payments for the care they provide to Medicare patients. The Centers for Medicare & Medicaid Services also began to pay healthcare providers based on quality of care.

2019 will see full implementation of the Merit Based Incentive Payments System (MIPS), created under the Medicare Access and CHIP Reauthorization Act of 2015. MIPS was designed to improve health outcomes, tie payments to cost-effective care, and encourage the use of healthcare information. The system measures performance based on data reported in four areas: Quality, Improvement Activities, Promoting Interoperability, and Cost.

Currently, MIPS is intended only for providers who are billing Medicare Part B more than $10,000 in claims per year, and excludes social workers and other behavioral health providers.

However, behavioral health and addiction treatment providers should keep an eye out for further developments involving MIPS and other VBP programs, as they could indicate the future of VBP models for behavioral health.

Why is VBP a challenge for behavioral health?

While VBP is heavily reliant on data, many behavioral health providers do not use standardized metrics to measure patient outcomes. In behavioral health, patient goals and outcomes are often subjective and highly individualized.

Because data is so important in VBP, an appropriate EHR system is crucial for recording patient outcomes and population health management. Behavioral health and addiction treatment providers who are preparing to move to VBP models may want to consider adopting an EHR solution tailored for the unique needs of their specialty.

BestNotes is a HIPAA compliant Customer Relationship Management and EHR database system designed specifically for you. Learn how our unique features can help you add value to your practice.

Contact us to learn more about BestNotes today!

date:  Feb 27, 2019
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Behavioral Health and Workplace Wellness

Workplace wellness programs have gotten a lot of attention in recent years. Research shows healthier, happier employees can improve productivity and lower costs.

Most workplace wellness programs, however, tend to focus exclusively on physical health. In fact, behavioral health factors can have just as much of an impact on employee and workplace health.

Here’s how your organization can better incorporate mental and behavioral health into your workplace wellness plan.

What behavioral health issues impact employees?

Employees in all industries can experience behavioral health issues in the workplace, but what about when behavioral health is your work?

Behavioral health clinicians and addiction treatment providers work with patients on deeply personal issues. Many patients have multiple health conditions that are difficult to treat.

Addiction treatment providers also face heavy workloads from staffing shortages and increased, complex patient needs. Regulatory and documentation requirements also can create stress among behavioral health providers and reduce their sense of control at work..

Some mental health issues that can affect behavioral health and addiction treatment providers in the workplace include:

Loneliness
Stress and anxiety
Depression
Workplace bullying
Addiction or substance abuse
Work-life balance
Clinician burnout

Why should employers be concerned about workplace behavioral health issues?

While most people would prefer to keep their work life separate from their personal life, work-related stress can bleed into non-work hours. Likewise, troubles at home can affect our mood and performance at home.

Behavioral health, like stress and depression, affects physical health, which drives up health costs. Some effects include a weaker immune response, increased blood pressure, sleep disruptions, and lower physical activity.
Mental health struggles can cause employees to withdraw mentally, which reduces teamwork and communication, reducing productivity.
Stress, depression, and poor health can increase absenteeism and employee turnover.
Unaddressed mental health issues at work can lead to medical errors, reducing quality of patient care.

How can you incorporate behavioral health in your workplace wellness program?

No matter your workplace wellness program, there is room for behavioral health. Even without a formal wellness program, behavioral health practices are easily incorporated into any workplace culture, .

Make a plan for your wellness program, with clear goals and ways to measure success.
Ask employees for feedback to determine what they want most in a workplace wellness program.
Try to incorporate physical activity into your workplace wellness program, as this can have a major impact on mental health. This may include gym memberships, fitness classes, or a dedicated exercise space in the office.
Encourage employees to connect on an appropriate personal level, which can help reduce loneliness.
Rather than stigmatizing time off work, encourage employees to use their sick days and vacation time. This encourages work-life balance, reduces employee stress, and improves morale and workplace engagement.
Rethink work hours and structure, offering flexible hours and telecommuting options wherever possible. Consider adding remote telehealth as a service, allowing therapists to meet with clients remotely.
Create a workplace culture that encourages collaboration and feedback, in which team members share each others’ burdens and communicate regularly.
Make sure your current employee health plan includes some form of mental healthcare.

Encourage a Healthy Workplace With BestNotes EHR

BestNotes EHR solutions are built with behavioral health and addiction treatment providers in mind to help make your work less stressful. Features like task management and customized calendars help you stay organized, not frustrated. Contact us today to learn more.

date:  Feb 21, 2019
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What You Should Know About Value-Based Care

Value-based care has gained traction in recent years, and it is expected to be a significant trend in the global healthcare market in 2019.

Compared to other specialties, behavioral health has been slow to adopt a value-based payment (VBP) model. As mental and behavioral health draws more attention and addiction-treatment needs persist, providers must prepare to transition their practices to VBP.

A major factor in the acceleration of value-based care is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This law changed the payment system for doctors who treat Medicare patients.

Payment provisions under MACRA will take effect this year, prompting many providers to focus more on overall patient health and positive outcomes. However, many payers are still working out the best methods for incorporating VBP into the realm of behavioral health.

Slower Behavioral Health Adoption of Value-Based Care

While the VBP is gaining traction among physical healthcare providers, behavioral health services, including addiction treatment, have lagged behind. This is partly due to the difficulty in defining outcomes for behavioral health.

VBP is meant to reward care quality and cost-effectiveness, compared to the traditional fee-for-service (FFS) model. This means that VBP focuses more on patient outcomes.

Patient outcomes can be difficult to define and measure in behavioral health and addiction treatment. Generally, “improved functioning” is the main goal, which can look different for each patient or condition.

VBP has become popular in the real of physical health because many providers have been criticized for allegedly over-diagnosing, over-treating, and over-prescribing. In contrast, behavioral health issues tend to be underreported, and treatment resources underutilized.
According to one study, most patients referred to psychotherapy only attend one or two sessions.

Importance of Changing to VBP in Behavioral Health

While it is challenging to define value and outcomes in behavioral health, the use of VBP models can significantly help reduce healthcare costs. In 2013, mental health disorders were found to be responsible for $201 billion in health spending.

Most Medicaid VBP arrangements are focused on physical health services, but many payers have become more interested in applying the VBP model to behavioral health, as well. According to a 2015 report by the Medicaid and CHIP Payment and Access Commission, Medicaid is the largest payer for behavioral health services in the nation, accounting for 26 percent of total spending.

Behavioral health and addiction treatment patients often have complex health needs that can increase emergency department visits. This patient population also tends to have concurrent disorders that drive up health costs.

For example, one study of patients with both depression and diabetes suggested that including interventions to reduce depression was more cost-effective than standard diabetes care alone. This requires more collaboration and data-sharing among different providers.

Outcomes are important for the VBP model, but you can’t determine outcomes without data. Fortunately, the right EHR program can help you track this information.
Enter and track patient data accurately with BestNotes, a behavioral health EHR solution built specifically for your practice’s needs. Contact us today to ask questions, learn more, or schedule a live demo.

date:  Feb 12, 2019
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How to Tell the Difference Between an EMR, EHR, or PHR

Many people use the terms electronic medical record (EMR), electronic health record (EHR), and personal health record (PHR) interchangeably. This can confuse patients, consumers, and even regulators.

Although an EMR, an EHR, and a PHR are very similar in practice, there are some differences in how the terms are used.

Similarities Among EMR, EHR, and PHR

The three acronyms are confusing mainly because the terms they represent already share many similarities:

These are all records—that is, collections or repositories of data—that contain health-related information
Like EMRs and EHRs, PHRs also can be stored electronically and managed by some type of software
Although only PHR has “personal” in its name, all three terms may involve information of a personal nature
Only two of the three terms use the word “health,” but all three are health-related.

Definition of Electronic Medical Record (EMR)

According to HealthIT.gov, an EMR is the digital version of the patient charts created by individual health facilities and providers. The data included in an EMR are primarily used to diagnose and treat a patient’s concern. Unlike paper charts, EMRs can help clinicians track and monitor data over time and identify patients with particular needs.

The biggest drawback to an EMR is that it is confined to a single provider. Traditionally, EMRs do not support interoperability or the exchange of information. While the EMR is an improvement over traditional paper charts, its failure to use standards-based interoperable data can fall short of “meaningful use.” A 2008 report by the National Alliance for Health Information Technology noted that the EMR term could become obsolete.

Definition of Electronic Health Record (EHR)

Like an EMR, an EHR is also a digital version of a patient’s chart. An EHR, however, includes data from all clinicians and facilities involved in a patient’s care. All authorized providers and staff can access this information to treat a patient.
Such information includes:

Diagnoses and allergies
Medications and other treatment plans
Immunization dates
Test results and radiology images
Provider contact information

The EHR follows the patient, and is not specific to a location. For example, an addiction treatment client may receive care from a family doctor, testing laboratory, psychiatrist, and substance abuse treatment clinic. Each of these providers would contribute that client’s data to the same EHR. This makes the EHR essential for data sharing and coordination of care.

Similarities Among EMR, EHR, and PHR

The three acronyms are confusing mainly because the terms they represent already share many similarities:

These are all records—that is, collections or repositories of data—that contain health-related information
Like EMRs and EHRs, PHRs also can be stored electronically and managed by some type of software
Although only PHR has “personal” in its name, all three terms may involve information of a personal nature
Only two of the three terms use the word “health,” but all three are health-related

According to HealthIT.gov, an EMR is the digital version of the patient charts created by individual health facilities and providers. The data included in an EMR are primarily used to diagnose and treat a patient’s concern. Unlike paper charts, EMRs can help clinicians track and monitor data over time and identify patients with particular needs.

The biggest drawback to an EMR is that it is confined to a single provider. Traditionally, EMRs do not support interoperability or the exchange of information. While the EMR is an improvement over traditional paper charts, its failure to use standards-based interoperable data could fall short of “meaningful use.” A 2008 report by the National Alliance for Health Information Technology noted that the EMR term could become obsolete.

Definition of Electronic Health Record (EHR)

Like an EMR, an EHR is also a digital version of a patient’s chart. An EHR, however, includes data from all clinicians and facilities involved in a patient’s care. All authorized providers and staff can access this information to treat a patient.
Such information includes:

Diagnoses and allergies
Medications and other treatment plans
Immunization dates
Test results and radiology images
Provider contact information

The EHR follows the patient, and is not specific to a location. For example, an addiction treatment client may receive care from a family doctor, testing laboratory, psychiatrist, and substance abuse treatment clinic. Each of these providers would contribute that client’s data to the same EHR. This makes the EHR essential for data sharing and coordination of care.

Definition of Personal Health Record (PHR)

What makes PHRs different from EMRs and EHRs is who controls it. Although the data kept within a PHR may come from an EHR, the patient is in charge of PHR management and access. This helps patients collect and manage their own health information in a private, and confidential environment.

Patients can enter information into their PHRs themselves, such as their lifestyle habits or over-the-counter medications. They also can add data from other sources, including home monitoring devices and additional care providers.

The above definitions of an EMR, EHR, and PHR are tied to the concepts of meaningful use and interoperability. As these ideas are refined and implemented, the definitions also may evolve.

An EHR to Support Both Providers and Patients in Behavioral Health and Addiction Treatment

BestNotes EHR solutions helps streamline your behavioral health practice and improve patient care. Contact us today and request a live demo to learn more about what we can do for you!

date:  Feb 06, 2019
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Idaho Addiction Treatment News Roundup: January 2019

From medication-assisted treatment (MAT) availability to opioid alternatives, there have been numerous recent stories and studies involving substance abuse and addiction treatment in Idaho. Here’s are the stories making headlines in the state in recent weeks.

Idaho Medical School Emphasizes Opioid Alternatives

Idaho College of Osteopathic Medicine in Meridian, the state’s first medical school, is working to reduce addiction by teaching its students about alternatives to opioids. This is part of the school’s emphasis on osteopathic principles and practices, which consider the whole person and all factors that may be contributing to disease or injury. Students who graduate from the college will have spent at least 200 hours in a learning lab, gaining hands-on experience in treating everyday issues with non-opioid techniques.

More Idaho Teens Struggling With Substance Abuse

The Idaho Youth Risk Behavior Survey found that more than 7,000 high school girls in Idaho used prescription drugs without a prescription in 2017. The study surveyed 1,818 high-school students from 53 public schools across Idaho.

Alexis Pearson, a treatment supervisor for the Treatment and Recovery Center in Twin Falls, noted that marijuana and alcohol use have been the main substance-abuse problems among students. Use of opioids and heroin, however, are beginning to catch up.

Children as young as 13 have sought help from the center, Pearson says. Many students who seek help often have parents who struggle with addiction.

Idaho Lacking in Medication-Assisted Treatment Facilities

Among those U.S. facilities that treat substance use disorders, only a small minority offer MAT, researchers have found. According to research published in the January issue of Health Affairs, Idaho has one of the lowest proportions (16.8 percent) of treatment facilities offering any FDA-approved medication. The study was conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, who analyzed national survey data from 2007 to 2016.

Of those facilities that do offer MAT, only 6 percent offer all three FDA-approved medications. Ideally, facilities should offer all three medications (buprenorphine, naltrexone, and methadone), since patients may see different outcomes from different drugs.

Get the Best EHR for Addiction Treatment Providers in Idaho

Need to streamline your practice and improve patient outcomes? BestNotes EHR was created with you in mind!
Contact us today to learn more about an EHR and CRM solution developed specifically for behavioral health and addiction treatment providers.

date:  Jan 29, 2019
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