Health systems across the U.S. are testing a range of financial and operational strategies to sustain and expand behavioral healthcare services, from investing in higher-reimbursed treatments to reconstructing intake and funding models. Five leaders told Becker’s how their systems are balancing access, efficiency and financial pressure through five key approaches.
1. Incorporate high-margin services to offset costs: Bernard Jones, vice president for behavioral and mental health and the psychiatry department for Somerville, Mass.-based Mass General Brigham, told Becker’s the system has looked to services that advance patient care and are favorably reimbursed, including interventional psychiatry and procedural services.
“If we can sort of augment our ability to deliver those services in a way that not only are good for patients, but ultimately lift our financials, that’s both good for us,” he said. “It reduces our need for subsidy, but it also allows us to cross subsidize within our own department, those services that have not yet been adequately reimbursed in the ways that we would like them to.”
2. Combine care models for financial flexibility: Salt Lake City-based Huntsman Mental Health Institute combines behavioral healthcare models to provide financial flexibility, Teresa Lopez, director of behavioral health integration, told Becker’s.
The institute combines the primary care behavioral health model — which offers same-day, and sometimes one-time, therapeutic visits during a patient’s physician appointment — with the evidence-based collaborative care model to treat patients with anxiety or depression.
“It was really important to us that we were helping to push our system toward more of that value-based care work through the collaborative care model, but also because we wanted to be able to capture the billable work being done through psychotherapy brief visits.”
3. Simplify the intake process: Marlton, N.J.-based Virtua Health brought behavioral health intake and insurance authorization in house, expecting to reduce denials, improve throughput efficiency and better understand the true cost of caring for behavioral health patients across settings.
When patients in the emergency department cannot be placed quickly — depending on volume and acuity — they are admitted to medical-surgical beds. These admissions are not reimbursed because the patient does not have a primary medical diagnosis, Russ Micoli, vice president of behavioral health services, told Becker’s.
“Your cost data in terms of what is costing you to be able to manage that patient in the emergency room or on the general medical floor can help to incentivize,” he said.
4. Capitalize on and manage philanthropic opportunities: Maurizio Fava, MD, chair of psychiatry at Mass General Brigham, told Becker’s philanthropy has been used as a source of discretionary funding by each hospital and investigator.
“Now we have a single team that oversees fundraising and philanthropy,” he said. “There will be donors that are going to say, ‘I would like to fund research in this area,’ and that may lift all boats in terms of philanthropic support across the entire department.”
Over the past few months, several health systems have received notable gifts for behavioral health, including Los Angeles-based UCLA Health, Monterey, Calif.-based Montage Health and Boston Children’s Hospital.
5. Lean on braided funding: Houston-based Harris Center for Mental Health and IDD is combining multiple public and partner funding streams, managing about 70 grants or contracts to create a continuum of care.
The organization created a revenue cycle team dedicated to billing as well as a separate data team and data collection system to track outcomes. Nearly all funding is expense-based reimbursement, Wayne Young, CEO of the center, told Becker’s.
“We’ve got to be able to float that money up front,” he said. “Then we’ve got to customize the billing interaction and the timelines based on what that payer’s intentions and expectations are. They each have their own payment timeline. They often each have their own invoicing kind of framework and model and the documentation required to prove up those expenses.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
