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Behavioral Health Gains Momentum in Reimbursement


Three initiatives are changing the momentum for behavioral health and chronic care reimbursement.

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.

Secondly, the Cures Act will also push for greater interoperability between physical and mental health care providers. Interoperability has long been the goal, but it’s yet to be truly achieved. The Cures Act ruled vendors found to be information blocking and preventing interoperability will be fined up $1 million.

The hope - through the Cures Act - is that healthcare technology vendors will have greater opportunity to integrate with one another and better enable the care coordination between the two sides. This level of cooperation will begin to eliminate the barriers to reimbursement that exist today, simplifying the patient’s explanation of benefits and insurance claim submissions for faster returns.

The Collaborative Care Model & Behavioral Health Integration

In 2017, CMS introduced the psychiatric Collaborative Care Model (CoCM) and Behavioral Health Integration (BHI) under the successful Chronic Care Management (CCM) services initiative.  Although reimbursements through these programs still favors primary-care physicians, the two initiatives are mainly geared toward integrating the behavioral health community.

Beginning this past January, four new BHI billing codes were introduced, three of which apply to care provided under the psychiatric CoCM model. Ultimately, these new additions are designed to facilitate greater access to behavioral care and integration between the physical and mental health communities in regard to whole patient care.

With the mental health community able to participate in a patient’s collaborative care, it’s already easier to combine behavioral health and physical health treatment plans. The novel ability to establishing a complete cost analysis for these long-term, interdisciplinary treatments allows physicians to focus on care without worrying about risk to the practice.

Emphasis on Patient Satisfaction

Patient satisfaction isn’t directly tied to reimbursement, but the shift toward value-based care demands a focus on optimizing the patient experience in order to positively impact a practice’s bottom line. This is particularly true - and challenging - for patients with behavioral and chronic conditions.

According to a study conducted by West, patients are willing to leave an established relationship with a physician, with nine in 10 saying they would change providers if they were not completely satisfied. Additionally, 74 percent indicated they would put off scheduling or delay care if they weren’t satisfied with their provider. These are concerning numbers when considering a patient that is diagnosed with a behavioral health condition - when treatment consistency and physician trust are imperative to successful care.

Luckily, studies have already shown patients’ top priorities when it comes to overall satisfaction:

•Shorter wait times

•Advance knowledge of treatment costs

•Not feeling rushed during an appointment

•Providers possessing high levels of expertise treating a specific illness

•Easy-to-schedule appointments

Providers should consider this list especially crucial for behavioral health patients. This is especially the case with their constantly dealing with the front office and how easily barriers will deter these patients from scheduling their next appointment.

Charlie Hutchinson is the chief financial officer of InSync Healthcare, a provider of solutions for behavioral health and primary care practices that want to focus on patients, not technology. 

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