Over the next three to five years, services for substance use disorders and mental illness are going to increasingly reflect the fast-paced changes spurred by the Affordable Care Act, parity, technology and a greater focus on prevention. After decades of spotty coverage, behavioral services are now being reimbursed more often, and payers of all types want to make sure they are getting value.
Caught up in the current of such trends are the accreditation bodies that validate the services and the providers who deliver them. Key changes in accreditation benchmarks are expected to roll out by 2020.
Primary care and behavioral healthcare providers are increasingly integrating, with the ultimate goal of comprehensive patient care. Accrediting bodies are taking a closer look at how to define integration.
“We’re already seeing physician practices in North Carolina doing active screenings for behavioral health,” says Teresa Harbour, associate clinical director with the Accreditation Commission for Healthcare (ACHC).
Is some cases, it’s the physician practices pulling in behavioral health providers to serve their patients, and in others, the behavioral health providers are hiring medical practitioners to address patients’ medical needs. Both aim to close the gaps in total patient care.
“That’s something we’re going to see growing,” Harbour says. “We can no longer have patients going in and out of the emergency rooms.”
Integration also aims to help reduce the cost of care and improve outcomes. Commercial insurers and the National Committee for Quality Assurance that accredits them are both pushing for behavioral health access in physician practices, she says.
“For accrediting bodies, the challenge will be to keep up with the innovations that come out of integration, as well as moving toward outcome measures,” says Kate Peterson, behavioral health surveyor for ACHC.
Newly emerging behavioral health homes are doing well so far, says Peterson. For example, opioid treatment programs (methadone clinics) have been a natural fit as health homes because they typically have a strong medical component.
ACHC is beta testing its integrated care services program and its behavioral health home program. Both are expected to be ready by the end of 2015.
The Joint Commission—which validates across many healthcare specialties—recently rolled out an integrated care certification and is working to engage behavioral healthcare providers.
“We will look at how organizations handle communication between settings,” says Tracy Griffin Collander, director of behavioral healthcare accreditation at the Joint Commission.
One clear problem for patients has been the difficulty of navigating from primary care and/or the emergency room to behavioral healthcare. Instead of the “warm handoff,” they are typically given a list of service providers and left to their own devices. Few actually access treatment, and it’s one of the reasons that integration of care is seen as essential.
Collander, a licensed social worker who formerly ran an addiction treatment program, also says that it is the responsibility of the behavioral healthcare provider of the future to make sure that its services are accessible to patients.
“The onus is on addiction treatment centers to be ready to catch that patient,” she says. “You have to make sure the hospital provider knows who you are, be ready to accept that referral, and most of all, you have to initiate that key dialogue.”
According to Michael Johnson, managing director of behavioral healthcare accreditation at CARF, accreditation will make a difference to the whole system, especially as new integrated models progress, such as Accountable Care Organizations (ACOs). Accreditation should indicate that outcomes have been demonstrated, and that there is organizational efficiency.
“I don’t think a hospital system that is responsible for managing finances in an ACO will be happy about going into business with an unaccredited behavioral health provider,” he says.
While there is agreement that outcomes must be measured, the measures themselves are up for debate.
“We want to measure evidence-based gold standards, but nobody has clearly identified those things that are gold standard,” says ACHC’s Peterson. “That will be one of the tasks as we move forward.”
But there’s nothing wrong with process-based measures if they are recognized as a proxy for outcomes, says Johnson. One of the challenges in the behavioral health market is that providers don’t know how to measure what is important to an individual person in an aggregate way.
“At the end of the day, organizations measure what the payers want them to measure,” he says. “As an accreditor, we’re not going to dictate what to measure.”