Accrediting organizations are paying close attention to the evolution of integrated care, raising the bar on what they expect from providers. Meanwhile, states have their own licensure rules, and managed-care Medicaid payers have accreditation expectations for programs to qualify for reimbursement. In fact, the state-contracted, commercial payer requirements of Medicaid providers have increasingly driven behavioral healthcare organizations toward accreditation.
The main purpose of accreditation is to create systems to improve care for the patient. But payers are interested in providers that are able to improve comprehensive care and thus reduce utilization, so health homes and integration are increasingly being used to measure quality.
The four main accrediting organizations in the field are on task to keep up with healthcare system demands and vet the providers that seek their seal of approval.
Formerly the Commission on the Accreditation of Rehabilitation Facilities
Michael W. Johnson, managing director of CARF International’s behavioral health accreditation, recalls the time when a CEO asked him to define the benefit of accreditation. Johnson responded: “Having a set of standards that are external to you and not influenced by local politics but represent a true measure of quality improvement strengthens your organization.”
For example, one of the historic problems in the behavioral health market is a written document for succession planning. Johnson believes there are a significant number of CEOs planning to retire—some fairly soon—yet only 35 percent have groomed anyone in the organization to step into their shoes.
CARF International, based in Tucson, Ariz., is a not-for-profit entity that aligns its standards with the philosophy adopted by most behavioral health organizations, including recovery-oriented, person-centered care. The organization’s history is rooted in the long-term recovery-based facilities that predominated in the substance use disorder (SUD) field, in which rehabilitation rather than medical treatment remains the focus.
And the addiction field is ahead of the mental health field when it comes to accreditation, according to Johnson.
“When I go to addictions-focused conferences, the organizations that are in the for-profit market or cater to the insurance industry recognize that they’re in business,” he says. “In the mental health world, it seems that unless someone is making them do it, it takes them longer to make the decision to become accredited.”
For-profit programs often have to convince payers of their value overall, and accreditation is one way to do that, he says. But it’s not just payers that want to see value.
Integration trends in the healthcare system as a whole call for behavioral health to align with medical providers. Most often a hospital-based system in a particular market has the competitive advantage, and behavioral providers would be smart to create integrated models with the local leading system, according Johnson. However, the hospital system likely will want to align its efforts with behavioral health organizations that are accredited, he says.
Johnson says with any accreditation, organizations should maintain a focus on quality improvement. CARF allows for accreditation of individual services.
“You might operate 15 different programs, but might want to get only 10 accredited,” Johnson says.
Accreditation is effective for three years, but there is also a one-year accreditation offered by CARF for providers who have “serious gaps that need to be addressed,” he says.
Cost: $995 for the application; $1,550 per surveyor day
Typical Survey: 2 surveyors, 2 days
Accreditation: 3 years
Programs accredited: 24,061
Sites with programs: 9,152
Tracy Griffin Collander, executive director for behavioral healthcare accreditation of the Oakbrook Terrace, Illinois-based Joint Commission came to the not-for-profit a year ago after six years with a Joint Commission accredited addiction treatment organization. Collander views accreditation as a partnership between the treatment provider and the accrediting organization.
In selecting accreditation, the treatment organization should take its own mission and values into account, she says.
Payers want to see national level accreditation in order to reimburse at higher rates, particularly when the provider has achieved health-home status. For example, in Maryland, The Joint Commission accredits and certifies behavioral health care organizations that function as health homes, which is required for reimbursement. The OTPs receive additional per patient reimbursement for managing care in a more comprehensive way.
Substance use disorder (SUD) treatment and eating disorder treatment are the top disciplines examined by insurance companies, Collander says, however, a low percentage of SUD treatment providers have such accreditation. For example, when Collander worked for Gateway prior to coming to The Joint Commission, care coordinators from a local Blue Cross Blue Shield plan would ask for proof of Joint Commission accreditation.
Because The Joint Commission accredits the entire organization, not just the program, she says accreditation leads to a “whole leadership structure” to rely on. Organizations are able to focus on continuous quality improvement by collecting data on risk points for addiction treatment services.