In the evolving landscape of healthcare, value-based care in behavioral health has steadily grown from an idealistic concept to a near inevitability. While the transition away from the traditional fee-for-service (FFS) model has been ongoing for years in various sectors of healthcare, behavioral health providers have only recently begun to embrace it with the urgency it demands. For decades, healthcare providers have focused primarily on delivering services and being reimbursed for each individual service rendered. However, as the industry continues to evolve, more behavioral health organizations are recognizing that the future lies in models that prioritize quality over quantity, risk-sharing, and accountability.
Although value-based care in behavioral health is still in its infancy, there is a growing push from forward-thinking organizations to design and implement models that integrate risk-sharing agreements, outcome-based measures, and accountability for the care they provide. Today, the conversation has shifted to one of preparation: how should providers position themselves for a swift and inevitable transition to value-based care in behavioral health if more payers fully embrace this approach?
The Growing Importance of Value-Based Care in Behavioral Health
Dr. Tom Britton, CEO of Accanto Health, a prominent eating disorder treatment company, made an important observation during the Behavioral Health Business’ VALUE conference. He noted, “If you’re in the fee-for-service model, you will be outdated very shortly if you don’t move quickly.” This sentiment encapsulates the growing urgency around shifting to value-based care in behavioral health.
For behavioral health providers, the implications are clear: continuing to operate within a fee-for-service framework will soon put them at a competitive disadvantage, as more and more payers and stakeholders push for a more sustainable and efficient approach to healthcare. However, it’s not just about adopting new payment models; it’s about aligning the entire organizational structure with the principles of value-based care in behavioral health—accountability, outcomes, and cost-efficiency.
Behavioral health organizations that hesitate to embrace value-based care in behavioral health risk falling behind the curve, while those that take proactive steps to incorporate VBC will not only improve patient outcomes but also position themselves as leaders in a rapidly changing industry.
The Benefits of Value-Based Care: A Focus on Outcomes
At its core, value-based care in behavioral health is designed to improve the quality of care by focusing on patient outcomes rather than the volume of services provided. Dr. Benjamin Nordstrom, Chief Medical Officer at Behavioral Health Group, succinctly captured the essence of VBC when he stated, “value-based care in behavioral health is too good of an idea to give up on.” He likened it to the adoption of electric cars—while the advantages of electric vehicles have been clear for years, it took time for widespread adoption due to various barriers. Similarly, value-based care in behavioral health faces hurdles, but its effectiveness makes it an idea that will eventually prevail.
For payers, the primary goal is often to lower overall healthcare costs while maintaining or improving the quality of care. Behavioral health plays a critical role in achieving this goal. Studies have shown that improving mental health can lead to significant reductions in overall healthcare spending. For example, Evernorth, the services division of the health plan company Cigna, found that outpatient mental health services can reduce a plan’s costs by approximately $1,400 per person in one year, and up to $3,100 per person over two years.
Providers that embrace value-based care in behavioral health will not only help reduce overall costs but also improve patient satisfaction and clinical outcomes. This is especially important in behavioral health, where early intervention and consistent care can make a significant difference in a patient’s long-term health and recovery. However, Dr. Britton was quick to point out that providers should not take on more accountability than they can control. “The very first ‘do’ is to determine your goals going in and where on the spectrum you are comfortable with risk,” he advised.
Behavioral health providers must have a strong understanding of their data, their patient population, and their specific goals to effectively implement a value-based care in behavioral health model. For example, a provider focused on treating addiction might set goals that focus on relapse prevention and long-term recovery, while a provider focusing on mental health disorders might set goals related to symptom reduction and improved quality of life.
The Complexity of Behavioral Health: Collaboration is Key
One of the primary challenges in implementing value-based care in behavioral health is the complexity of the care required. Unlike traditional physical health conditions, behavioral health often requires addressing multiple, overlapping needs, including mental health, substance use, and social determinants of health. Given this multifaceted nature of care, collaboration with other healthcare providers is essential.
Bend Health, a collaborative care provider that focuses on youth and young adult behavioral health, has embraced this approach by working closely with payers and other healthcare providers to share data and coordinate care. Dr. Monika Roots, President and Co-founder of Bend Health, explained, “The more we can share and collaborate, the better the care we can provide.” By leveraging data and integrating with other care providers, Bend Health is able to create a more comprehensive care model that aligns with its bundled payment strategy. This collaborative approach ensures that patients receive the full spectrum of care they need, from mental health treatment to physical health services.
The collaborative care model also helps ensure that patients are not falling through the cracks in the system. In behavioral health, it is not uncommon for patients to require treatment for multiple issues, such as addiction and trauma, that require different approaches and specialists. Through collaboration, providers can ensure that patients are receiving the appropriate level of care, which ultimately leads to better long-term outcomes.
Overcoming Challenges: Training, Data, and Measurement-Based Care
One of the most significant barriers to the widespread adoption of value-based care in behavioral health is the need for accurate and actionable data. Dr. Roots highlighted the challenge that many clinicians face when it comes to measurement-based care. “There are many practitioners out there that were not trained in measurement-based care,” she said. Clinicians may feel that outcomes tracking is subjective or just an additional burden. Overcoming this perception requires training and clear communication about the benefits of measurement-based care.
It’s essential that providers implement training programs that help clinicians understand how to track outcomes effectively and how this tracking ultimately improves patient care. By making these practices a part of the daily workflow, providers can create a more efficient and data-driven environment. Additionally, measurement-based care helps identify when a patient may need to be referred to a higher level of care, ensuring that they receive the appropriate treatment in a timely manner.
Tying outcomes tracking directly to improved care also helps clinicians understand why these measures are important. Dr. Nordstrom shared that integrating familiar tools, such as the Brief Addiction Monitor, into daily practice makes it easier for clinicians to adopt value-based care in behavioral health without feeling like it’s an added task. By framing outcomes tracking as a tool that enhances their practice, providers can gain greater buy-in from clinicians and other staff members.
Starting Slowly: The Importance of Incremental Change
For behavioral health organizations looking to make the transition to value-based care in behavioral health, Dr. Britton recommended starting slowly and building the necessary infrastructure over time. In his previous roles at American Addiction Centers and Gateway Foundation, he encountered resistance to large-scale shifts toward value-based care, particularly due to technological limitations and a lack of staff training. Providers should begin by adopting pay-for-performance models and gradually increasing their level of risk over time.
“It’s important to take an incremental approach,” Dr. Britton said. “If you don’t have a really good understanding of your data, if your staff are not trained, if you don’t have the needed technological infrastructure, you’re going to totally put your whole organization at risk.” By building capacity gradually, organizations can ensure they are not overwhelmed by the complexities of value-based care in behavioral health and can learn and adjust as they go.
The Case for Premium Payments in Value-Based Care
As behavioral health providers take on more responsibility under value-based care in behavioral health, they should be prepared to negotiate for premium payments. The value-based care in behavioral health model often requires providers to address a broad range of health issues, including physical health conditions and social determinants of health—none of which are typically covered under the traditional fee-for-service model.
Britton emphasized that providers should be compensated more for taking on these additional responsibilities. “The risk-shared model is: you will pay us more because we are assuming an expectation that our treatment will deliver better results,” he said. When providers deliver better outcomes, they help reduce overall healthcare costs, and the model becomes mutually beneficial for both providers and payers.
Additionally, Nordstrom argued that when providers deliver quality care that results in lower healthcare spending, it not only benefits the patient but also reduces human suffering. Payers who incentivize quality care help eliminate lower-quality providers from the market, ultimately improving the overall healthcare system.
Embrace Change, Build Capacity, and Lead the Way
The shift to value-based care in behavioral health is no longer just a possibility—it is becoming a reality. Providers who embrace this change will be able to offer better, more cost-effective care that focuses on improving patient outcomes. However, this transition requires careful planning, collaboration, and the building of necessary infrastructure.
Behavioral health organizations must understand the importance of data, train their clinicians, collaborate with other providers, and take an incremental approach to adopting value-based care in behavioral health. By doing so, they will not only stay ahead of the curve but will also lead the way in shaping the future of healthcare. Now is the time for behavioral health providers to move beyond the fee-for-service model and embrace the value-based care in behavioral health revolution.
