As we begin to chart our course toward Accountable Care Organizations, let us keep in mind that mental health and substance use disorder providers are often starting their journey from a different point of origin than are their medical counterparts. Let’s face it, behavioral health providers are often under-resourced and under-capitalized compared to MSOs, IPAs and hospitals. Facts being what they are, behavioral health is going to require some special handling and it behooves primary care, hospitals, integrated delivery systems and health plans to help them keep pace. While it’s true that all interested parties – behavioral health providers included – need to be able to carry their own weight in business terms, any ACO that fails to properly include behavioral health providers is destined to continue struggling with a significant share of otherwise unmitigated chronic care costs so the value proposition should be clear. In order to achieve a high performance health system that is organized to attain better health, better care, and lower costs, the behavioral health needs of patients and their families must be met with as much ingenuity, quality and precision as other conditions.
Behavioral Health Recommendations for ACOs
The following is a list adapted from one prepared by the Commonwealth Fund this week. Each recommendation amounts to a strong caution for integrated delivery systems who seek to develop ACOs – behavioral health is essential.
- Technical Support for Behavioral Health Providers – mental health and substance use disorder treatment providers have a long history of serving populations from the margins where profits are slim. Most behavioral health care provided for in America is financed by Medicare, Medicaid, Federal block grants, State general funds and other government grants. Consequently, the lion’s share of providers are smaller and not-for-profit entities and their transition to ACOs will require a steep curve and additional support in the development of infrastructure. Agencies/communities interested in developing ACOs are advised to extend technical assistance and training to all viable providers. Information technology is chief among the needs for technical assistance.
- Integrated Care– truly effective ACOs will ensure that a foundation of integrated primary and behavioral health care is available for their members. While the initiative to integrate care has been around for more than a decade, there is a great deal of room for improvement. Accountable care must be highly integrated so the catalyst for improved implementation is certainly there.
- Accountability for Behavioral Health – the most accurate measures of quality care, patient care experiences, population outcomes, and total costs must include mental health and substance use disorders. ACOs are advised to develop systems of care that can be held accountable for the quality and cost of behavioral health treatment from the beginning.
- Informed Patients– ACOs must inform, engage and educate patients and their families. Nowhere is the need greatest than among those members and patients with behavioral health conditions. Many decades of fierce stigma and lack of access to services must be overcome with clear, friendly and readily available information and outreach.
- Commitment to Communities - serving the entire community has long been the mission of behavioral health providers – many of whom also serve social service functions. Linkages between community assets, case management and social work are vitally important to the most vulnerable populations, those suffering from disabilities and those suffering from multiple chronic conditions. The form and function of ACOs must remain true to community involvement and enhancement and avoid devolving into business entities that neglect their social and civic responsibilities.
- Reward High Performance in Behavioral Health – as much as ACOs represent a gold rush among business interests, it will be critically important that behavioral health providers be included in models that involve shared savings. Shared incentives will not only promote the right kinds of linkages and coordinated care, they will demonstrate a willingness to view behavioral health conditions and providers as equally deserving of respect.
- Innovative Payment Mechanisms for Behavioral Health – behavioral health providers are eager to look for new and creative ways to be reimbursed. They are uniquely positioned to offer services on case rates and the basis of episodes of care. There are providers that are ready to serve in roles such as health coaches, case managers, and health educators that can be supported by full-time salaries as opposed to purchasing services on a fee-for-service basis.
- Timely Monitoring - data collection, aggregation, analysis and feedback must include and address behavioral health needs and providers. Without data and reporting, most of our other goals and objectives cannot be met.