Value-Based Payment Models for Behavioral Health and SUD Providers

Beginning with the Medicare Improvements for Patients and Providers Act of 2008 and the Affordable Care Act in 2010, value-based payment (VBP) models have become increasingly common in Medicaid contracts.

With the Center for Medicare & Medicaid Services (CMS) paving the way, some private payers have moved to value-based contracts (VBC). Now behavioral healthcare and substance use disorder providers like Groups Recover Together have also adopted VBCs in negotiating with CMS and other payers.

Value-based contracts require that certain performance metrics be met for reimbursement, rewarding providers for patients’ improvement. This is in contrast with a traditional fee-for-service provided contract. While the latter model may seem intuitive, there are some notable advantages to VBP.

The value of value-based payment for CMS is obvious: cutting costs. For providers, VBP emphasizes trust between payer and provider and incentivizes quality over quantity in providing services. With higher reimbursements come improved patient and organizational outcomes. Our communities as a whole benefit from a higher healthcare standard, improvement in mental health metrics, and effective, evidence-based treatment of substance use disorders.

The downside for providers, however, is risk. “Will I provide services that I am never reimbursed for?” Value-based payment is something of a catch-all term. SAMHSA-HRSA Center for Integrated Health Solutions gives an example of several VBP models with increasing accountability in the graph below. With each degree of accountability, reimbursement and patient improvement become more linked.

Even for behavioral healthcare professionals that invest in their clients and provide great care, it can be concerning to adopt a reimbursement model based on their outcomes if you don’t have to. Providers interested in VBP should make sure the model they choose is the best fit for their organization and level(s) of care.

Image From SAMHSA-HRSA Center for Integrated Health Solutions

The National Council for Behavioral Health advises that providers ask themselves these questions before adopting a value-based contract:

  • Does the contract contain the flexibility you need for patient care?
  • Will the contract cover your actual costs?
  • Are the outcomes you will be required to measure the right ones?
  • Will the outcomes add meaning to your practice?
  • Will they accurately indicate if patients are being supported in their overall health and recovery?

Depending on the clients you serve and other factors, the value in value-based payments may be measured using any of these scales:


See AZZLY Rize: Outcome Measurement Tools

As you prepare for VBP, it’s crucial that you have the necessary outcome measurement tools in place. An all-in-one electronic health record system specialty-specific to behavioral healthcare and addiction treatment provides the required tools to support your facility’s outcomes, both clinically and financially.

Our solution AZZLY® Rize™ is an all-in-one EHR/RCM/PM solution. We offer Integrated Care Pathways™ specific to behavioral healthcare by providing a very individualized chronological medical record of each service or event provided during an episode of care. By connecting a patient’s diagnosis, to medications (if any), to labs, to their individual treatment plan, to the selected outcome measurement tool for real-time auto scoring and relative risk display, to adjusting the patient’s goals in the treatment plan review, to adjusting the levels of care or frequency of services offered and to be able to filter and show a day, a week, a month, a quarter, a year view in one view, one report can be very meaningful during a UR review, a chart audit and as important when calculating the improved clinical outcomes of the population that you serve.

AZZLY Rize’s outcome measurement tools library of assessments and surveys, without additional costs, allow you to keep track of your patients’ outcomes and keep an eye on quantitative measures of your success.

The next step is a discovery call. If you think that our solution could be a value for your organization, fill out this brief form, and you will receive a demo of AZZLY Rize at the email you provide. An AZZLY EHR and Billing Specialist will reach out to evaluate your needs and see if we are a good fit.

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