Challenges & solutions in value-based care

Exploring value-based care challenges & solutions in behavioral health: tackling mental health costs & system hurdles.

VBC Challenges to Consider

Although the pandemic has intensified and increased the visibility of mental and behavioral health problems and the strain they place on our healthcare system, this burden far predates COVID-19. According to McKinsey, untreated mental illness costs the U.S. as much as $300B annually. Health plans in the United States are increasingly shifting away from traditional fee-for-service (FFS) reimbursement toward value-based care (VBC) models, which incentivize the quality of care as opposed to quantity. Although the promise of high-quality, cost-effective care is alluring, the adoption of and engagement in these programs has proven challenging for both plans and providers alike. Barriers include a lack of resources to support VBC programs, technology interoperability challenges, continuously evolving policies and regulations, unpredictable revenue streams, and difficulty collecting and reporting data.

‍

The intersection of physical and behavioral health

In contrast to physical health, mental and behavioral health are in a nascent stage of VBC adoption. Given that general healthcare spending is two to three times greater for patients with a mental or behavioral health diagnosis than for those without, care delivery models emphasizing efficacy and savings are particularly appealing.

There are compelling reasons for health plans and providers to innovate in this area, despite the general complexities of VBC and barriers specific to mental and behavioral health.

Value-based care is a necessary first step toward unburdening our behavioral healthcare system

Although VBC is not an all-encompassing solution, it is a meaningful place to start. Both the Centers for Medicare & Medicaid Services and commercial payers have begun to dabble in mental and behavioral health VBC programming. The initial results demonstrate improved psychological outcomes, millions of dollars in cost savings, and reduced utilization of expensive medical care for comorbid physical conditions.

Expansion of similar programs to more providers is an obvious next step, but numerous barriers obstruct this path forward:

Provider reimbursement is cumbersome and costly, and not currently aligned with mental and behavioral health outcomes.
The field has not agreed on meaningful metrics with which to measure provider performance.
Providers lack the technical infrastructure to support VBC program implementation.
Mental and behavioral health continues to exist in one silo while physical health exists in another, preventing treatment of the whole person and related benefits from being realized.

Health plans, providers, and employers will need to work together to remove these obstacles. But payers also are in a unique position to advocate for VBC programs, bridge gaps across stakeholders and capture the value associated with integrated care. The future of value-based care is now.

‍