Reimbursement parity, hybrid care among top issues for behavioral health leaders

Behavioral health leaders have recently spoken with Becker's about issues including value-based care and reimbursements.

Editor's note: Responses were lightly edited for clarity and length.

1. "We're excited to see more attention and interest in severe mental illness, especially from the digital health community. The lack of providers with specialization or training in these areas is worrying, especially as it becomes easier and more appealing for providers to work with lower acuity patients and families. We're hopeful that digital delivery and coordinated care solutions will help amplify access to the right professionals." -- Stephanie Greer, PhD, CEO and co-founder of Akin Mental Health, on behavioral health trends including the family-first approach.

2. "Identifying patients who pose a risk to teammates is one of the key factors in decreasing the potential for violence. Unfortunately, because violence is not predictable, universal screening should be a part of every patient's medical record. Suicide screening is considered our fifth vital sign. Let us work together to make the potential for violence our sixth." -- Jennifer Ziccardi Colson, RN, BSN, Charlotte, N.C.-based Atrium Health's chief nurse executive and vice president for the behavioral health service line, on workplace safety.

3. "True reimbursement parity for behavioral health services is the number one issue I am following, because I believe this is the root driving cause of most of the challenges faced by behavioral health providers. The answer is not just to provide more grants, start-up funding, or funding of new kinds of services. Lack of adequate access to behavioral healthcare and lack of adequate workforce, for example, are fundamental because most behavioral healthcare providers cannot meet direct costs of care from payments alone.  

This chronic under-reimbursement of behavioral health services is in and of itself an example of the lack of parity for behavioral healthcare.

Unlike other medical practices, psychiatric and some addiction services do not have “physician extenders” because the very nature of behavioral health disorders involves one-on-one work between the provider and the patient, and the provider cannot “delegate” pieces of individual psychotherapy and treatment. Counseling or psychotherapy visits cannot be completed in 15 minutes.. A payment system that fundamentally is time-based does not permit a financially sustainable outpatient behavioral health practice.

The current payment system primarily recognizes physical procedures, which require equipment, as worthy of higher reimbursement. The system must show monetary value that the “equipment” used in behavioral healthcare is the provider’s mind and relationship to the patient, and that the tools to improve health are not just those that are tangible. To truly value behavioral health and achieve true parity, we must fundamentally change the way we reimburse behavioral health providers. This is the only path to a sustainable behavioral healthcare system. " -- Sabina Lim, MD, senior vice president of behavioral health safety and quality and system medical director of regulatory and government affairs at New York City-based Mount Sinai Health System, on her top issues for behavioral health.

4. "If you have a heart problem, you'd get your blood pressure taken and you'd have that measured, with a course of treatment determined afterward. You'd have an objective measure. In behavioral health, those things exist, but aren't commonly used and aren't commonly paid for. But over time, there have arisen clear methods in which to get paid for that. There is a procedure code called 96127. It's an add-on procedure code, where the provider is applying assessments to patients. So when a patient is at intake, they do an assessment to get an objective measurement of that patient before they start treatment. It's on a rating scale." -- Ram Krishnan, CEO and board director of behavioral health EHR and practice management platform Valant, about switching to measurement-based care.

5. "I think that growth is going to be in the hybrid space from a care perspective. I also see the collaborative care model and other models continue to allow growth of mental health care access to happen even with a limited workforce. I also think that growth in the mental health space will be geared more towards early intervention and prevention and I hope that the mental health system will continue to evolve to a less reactionary space [and not] wait until a patient is in crisis before they receive mental health care." -- John Brewer, DNP, vice president of behavioral health at a top children's hospital, on behavioral health's growth in the future.

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