Looming Medicaid redeterminations and funding cuts have heightened pressure on behavioral health providers to justify costs. Clear patient outcome data can build trust with payers, but too many report demands risk overwhelming staff.
Leaders agree on the destination: a system in which payers, providers and patients have confidence in care. The best path to get there however, is disputed.
For Tammar Attallah, vice president of Salt Lake City-based Intermountain Health, better measurement systems are a way to gain payer confidence. He has called for a disruption in the space, something he said private equity is trying to do. In private equity, systems and payers depend on measurable outcomes in a more meaningful way than the industry currently does, he said.
“If there’s no way to know whether people are getting better or not, it’s really hard for payers to understand whether or not their members are getting quality care. What is [quality] defined by?” Mr. Attallah said. “In order for payment models to change, there needs to be greater accountability for clinical outcomes by providers.”
Providers are pushed for more measurable outcomes, and demand for services continues to rise, placing payers in a position of control, he said. Providers can then choose to go private, but this could exacerbate one of behavioral health’s biggest problems: continued access to services.
Yet the challenge of consistently capturing data persists. From establishing a baseline to continuously tracking progress throughout a patient’s care journey — which can span a lifetime — measurement remains difficult.
However, Mr. Attallah said, this process generates additional data that can inform proactive population health strategies. Quantitative and qualitative data — from standardized tests and patient questionnaires — provide valuable feedback.
“If we’re not doing both of those [identifying early and treating effectively], then we don’t know,” he said. “It’s not fair to be asking for more money, more money, more money, when we don’t know whether people are getting better or not.”
For Chris Perry, vice president of quality and risk management at Alpharetta, Ga.-based Perimeter Health, requirements from regulators and payers have grown rapidly, but they provide little evidence that the added paperwork improves patient safety.
“We’re getting increased regulatory scrutiny from not just CMS and The Joint Commission, but we’re getting a lot of regulatory scrutiny from payers being more involved, wanting more reports, wanting more transparency,” he said.
He added that a single incident can trigger multiple notifications to the state, payers, case workers and family members that becomes a burden to his team. The process often involves hefty administrative work. With some reports being standardized and others requiring their own framework, it takes time and resources to manage hundreds of patients.
“If it serves the patient, we’re happy to do it, but sometimes it’s just administrative work on our part, which then takes us away from what we should be doing, which is focusing on improving care and making sure we’re providing the safest care,” Mr. Perry said.
For smaller systems, having one individual to cover quality and risk may not be enough.
He said Perimeter will eventually have to hire more staff to keep up.
Even with technological advances that can ease the administrative process, behavioral health does not have the same funding to lean on as other sectors. Mr. Perry said his organization is still on paper, pointing to the lack of funding for an EHR. Any new investment in technology would require Perimeter to pay out of pocket.
