Value-Based Payment Systems

DoctorThe term ‘value-based payments’ is being thrown around a great deal in the behavioral health industry. It describes a new method of paying for healthcare that encourages providers to give each patient the best care possible. Currently, healthcare providers are paid for their services based on the number of patients they bring in the door, as opposed to the quality of care they provide. With value-based payments, providers are assessed on the care they give and are given incentives to improve their metrics. This system is currently being tested by a number of payers and providers, but it has not yet fully expanded to behavioral health.

Of course, the transition from fee-for-service payments to value-based payments has not been easy, and there are still many undetermined factors at play. The healthcare system has relied on a volume-based payment program for so long that the rough transition surprises no one. There was, initially, the issue of tracking performance. Metrics with which to measure the quality of a provider’s care had to be agreed upon. Currently, it looks as if many of the value-based programs are using inpatient quality reporting data. Part of the issue with expanding value-based payment programs to behavioral health is that quality may be more difficult to track in behavioral programs. Unfortunately, the measurement of metrics for value-based programs that are now present do not apply to behavioral health.

Another difficult transition is the shift in provider tracking. Instead of accounting for insurance companies and patients as if they are all the same, the care of all patients must be scrutinized individually. Providers have to compile evidence that they are meeting or exceeding standards for quality care at the lowest cost possible in order to get rewards for their hospital.

Despite the difficult transition from the old way of payment, it is speculated that a shift to value-based payment has the potential to improve the behavioral health industry as a whole. It will, for one, encourage behavioral health providers to give their patients quality, low cost care. Insurance companies typically do not offer reimbursement for mental health services, as they treat it as being separate from physical health services. Switching to a value-based program would change that. It would give insurance companies an incentive to cover more mental health services, a phenomenon that is woefully lacking today.

Overall, value-based payment systems are being heralded as the future of this country. They are looking to completely change the healthcare industry by focusing more on patient care that saves money in the long run by making sure there is less hospital readmission and costly care. While this is beneficial for medicine as a whole, it will have the biggest impact on behavioral health.

For more information, visit New Horizon Counseling Center.

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