Reinventing Compensation in Partnership: Forging a Joint Way Forward in Mental Health Care
In the realm of behavioral health, where mental illness is the leading cause of disability and care coordination is complex, the seamless transition of a patient from an inpatient setting to Intensive Outpatient Program (IOP) or outpatient care is crucial for maintaining their functioning and wellness. This transition, however, is not without its challenges.
At a recent Becker's Behavioral Health Summit, a speaker emphasized the need for collaboration and data transparency to overcome these challenges. The speaker, who has experience on both the payer and provider sides of healthcare, highlighted that aligning on quality and outcomes is a significant step towards building a healthcare system that delivers on its promise.
Currently, behavioral health care lacks a unified definition of high-quality care, with payers and providers often using different measures and standards. By sharing data such as clinical outcomes (e.g., PHQ-9 and GAD-7 scores), engagement metrics, and claims information, both parties can build a comprehensive, aligned view of what effective care looks like and track patient progress from severe symptoms to remission.
The speaker's platform, which is in-network with over 155 payers, measures clinical outcomes using tools like the PHQ-9 and GAD-7. Combining datasets from the platform and payers for a more complete view of quality and effectiveness is essential for this collaborative approach.
Transparent reporting of prices, volumes, and service patterns can help eliminate inefficiencies and "ghost rates," making it easier for both sides to manage costs and plan care collaboratively. This transparency, which extends beyond hospitals and insurers to include independent providers, enhances comprehensiveness.
AI-powered tools can streamline information exchange during utilization management reviews, identify care gaps, and recommend optimal care transitions by continuously analyzing clinical data. This supports timely access to care, reduces unnecessary hospitalizations, and improves population health management.
Real-time, transparent data enables payers and providers to anticipate member needs, intervene early, and share responsibility for outcomes. This builds trust, improves patient engagement, and supports better resource allocation.
All stakeholders in the healthcare industry deeply care about doing the right thing, ensuring parity in treatment, and helping people get the treatment they need. Navigating different interpretations of quality and value is challenging with 155+ payers, but collaboration among organizations in the healthcare industry is increasing, offering reason for hope. There's a shared understanding that no health exists without behavioral health.
Coordinating care continuity requires aligned incentives across the entire healthcare system. Aligned incentives should reward not just showing up, but delivering positive outcomes. Lack of alignment on outcomes makes it difficult to scale effective solutions. However, the speaker believes that data and transparency can change the situation, fostering trust, shared goals, and operational synchronization between payers and providers, laying a foundation for sustainable, value-based behavioral health care partnerships in the future.
- In the discussion of behavioral health, there is a need to bridge the gap between payers and providers, as both parties can contribute to building a system that delivers on its promise by aligning on quality and outcomes.
- To facilitate this, clinical outcomes and engagement metrics should be shared between payers and providers, such as PHQ-9 and GAD-7 scores, to create a comprehensive, aligned view of effective care and track patient progress.
- AI-driven tools can help streamline information exchange, identify care gaps, and suggest optimal care transitions, ultimately improving population health management and reducing unnecessary hospitalizations.
- Collaboration among organizations in the healthcare industry is essential for coordinating care continuity, as aligned incentives should reward positive outcomes, paving the way for sustainable, value-based behavioral health care partnerships in the future.
