Basics of Value-Based Care
The value-based care model is designed to get more attention across the healthcare insurance industry. This is still being moderated to be perfect to deliver quality in care and not a quantity, care that will reward or penalize healthcare providers for patient or client outcomes.
The ultimate goal of Value-Based Care is to keep all U.S. citizens healthy and drive down the cost of insurance.
CMS Value-Based Care Definition
According to CMS, value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim:
- Better care for individuals
- Better health for populations
- Lower cost
Value-Based Behavioral Health
What would it mean to adopt a value-based model in the behavioral health sector? It would require looking at the whole person physically and mentally, not just addressing a specific complaint or ailment.
“BlueCross BlueShield of Western New York is proud to partner with the region’s leading behavioral health care providers to introduce the first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses,” said Thomas Schenk, MD, senior vice president and chief medical officer at BlueCross BlueShield of Western New York.
Most recently, Blue Cross Blue Shield of Massachusetts used its value-based care model for primary care providers, Alternative Quality Contract, to create a value-based contracting agreement for dental providers.
In 2017, New York’s emergency department visits related to opioid overdoses were largely concentrated in western counties, according to the state’s opioid annual report of 2019.
At least seven counties located in the western part of the state had crude rates greater than or equal to 91.2 opioid overdose emergency department admissions for every 100,000 residents.
Total 15 New York counties fell into this quartile. 5 of these 7 had high rates of admission to an New York State Office of Addiction Services and Supports (OASAS) – certified chemical dependence treatment program, “high” being at or above 538.8 individuals per 100,000.
the National Council for Behavioral Health, in partnership with Montefiore Medical Center, Northwell Health, the New York State Office of Mental Health, and Netsmart Technologies, operated the Care Transitions Network (CTN) initiative for People with Serious Mental Illness (SMI). The Care Transitions Network supported 275 behavioral health practices across New York State, a majority of which were outpatient specialty mental health and substance use treatment settings, collectively serving over 258,000 Medicaid patients.
In 2019, UnitedHealthcare started covering physical therapy and chiropractic care benefits to help prevent increased reliance on opioids for pain treatments. The benefit extended to five states including New York and the payer intends to expand it in 2020 and 2021.
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