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.
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