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Payment and service delivery changes ahead

April 2, 2014
by Dennis Grantham
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Among the major changes projected for behavioral healthcare providers are these:


1) How people get into care. Historically, we’ve had a multi-step process that often takes weeks or months. If we’re going to survive, we’ve got to provide “open access”: people can get care when and how they want it, and primary care can refer people to you and know that service is going to be available. It sounds like a simple change—but that’s hard.

2) Length of care. “The notion of treatment that goes on forever is over," says Linda Rosenberg, CEO of the National Council for Behavioral Health. We have to look at ‘episodes’ of care, when people want to get services for a period of time – maybe weeks or months – but then go away until they decide to access care another time.  Historically, we’ve tended  to open cases and recommend that people receive care for long periods of time, then close the cases. Primary care docs don’t do that – your chart is always open and you come and go.”

3) Patient progress and outcomes. How will we partner with consumers, to capture and review their progress and consider changes in the direction of treatment? How will we connect with, collaborate with, or provide primary care for those whom we are serving?

4) Increased attention to trauma. “As our knowledge about the role and impact of trauma grows, it’s clear that providers have to be trained to treat it,” says Rosenberg. Trauma is recognized as a factor that increases individual vulnerability to mental health disorders, substance use, and chronic health conditions. “Trauma doesn’t cause mental or physical disorders, but it makes you less resilient - more vulnerable - to them.

5) Greater visibility and advocacy. “Substance use is probably our biggest public health crisis and we’ve got to be more committed to it than ever before. Coming together makes us stronger clinically and also on the advocacy side," Rosenberg adds. 


Transitioning from today's behavioral health business to tomorrow's

Business transitions

Today Tomorrow
  • Small business
  • Low margins, limited capital
  • Significant "research-to-oractice" gap
  • Part of larger business
  • Access to greater capital
  • Faster adoption of research-based methods

Service delivery transitions

Today Tomorrow
  • Long delays, limited referral
  • Smaller population, long-term care
  • Office-based
  • Limited outcome measures
  • Mental health and SUD treatment
  • Open access, reliable referrals
  • Larger population, episodic care
  • Office and technology-based
  • Patient-reported outcome measures
  • Integrated disease prevention and management
Payment transitions
Today Tomorrow
  • Fee-for-service
  • Inflexible, rule-driven
  • Bundled, capitated, shared risk
  • More flexible, innovative, and entrepreneurial