The last few years have ushered plenty of reimbursement changes for providers, especially those who treat behavioral health and chronic conditions. Long considered an overly complicated category that blurs the lines of interdisciplinary diagnosis and treatment, behavioral health and chronic conditions are continuing to rise and can no longer be ignored as a critical reimbursement gap.
Of the nearly 44 million Americans who are affected by mental issues, many of them aren't' able to receive the care they need due to reimbursement and integration challenges that have plagued behavioral health professionals and physicians. Providers are all too aware of rising patient financial responsibility, and are beginning to demand market incentives and solutions to minimize business risk without compromising care.
Thankfully, recent legislative action and nationwide mental health initiatives have spurred progress in achieving more effective integration between physical health physicians and mental health providers. Integration between the mental and physical health communities will allow for all providers to account for whole patient care, rather than a single portion, as well as enable easier payer and patient solvency.
Here are the top three legislative measures or initiatives changing the momentum for behavioral health and chronic care reimbursement.
21st Century Cures Act
The 21st Century Cures Act — also known as the Cures Act — represents a step in the right direction for behavioral health and care coordination.
Poor care coordination can be costly for patients. According to a study by the American Journal of Managed Care, insufficient patient care coordination can increase the average costs of chronic disease management by more than $4,500 over three years and patients were more likely to experience gaps in treatment.
Fortunately, the Cures Act looks to solve some of these pressing issues. Value-based reimbursement and other new models of care will help improve access to the appropriate mental health care that patients need. States will utilize coordinated specialty care models for the early intervention of psychosis, which hopes to deliver better outcomes through an optimized team approach.