Traditional fee-for-service reimbursement arrangements have long been the backbone of the U.S. healthcare system. However, there is increasing evidence that these models may be driving up costs for payers without delivering the desired results in terms of patient outcomes. A recent study by Cityblock Health, a leader in behavioral health value-based care, offers a compelling argument for why it’s time to rethink this traditional approach. Published in NEJM Catalyst, the findings show that integrating behavioral health services into behavioral health value-based care models can result in both significant cost reductions and better care for patients, particularly those enrolled in Medicaid and Medicare-Medicaid programs.
Study Findings: Significant Cost Reductions and Better Care
The study, conducted by Cityblock Health, focused on patients enrolled in their behavioral health program. According to the data, Medicaid and dually eligible patients who participated in the program experienced an 11.5% decrease in the total cost of care and a striking 19.7% reduction in inpatient treatment utilization compared to those not enrolled in the program. These findings highlight the potential advantages of behavioral health value-based care, which incentivizes health outcomes rather than the volume of services provided, as is the case in traditional fee-for-service models.
Ruby Mehta, the head of behavioral health at Cityblock, shared her thoughts on the significance of the results. She explained, “Ultimately, these findings are important because they demonstrate the effectiveness of integrating medical, behavioral, substance use disorder, and social care in a behavioral health value-based care model. When I see the results, I’m encouraged and optimistic about the impact we can have on some of the most vulnerable Medicaid members.” This is especially significant for populations that have historically struggled with access to comprehensive, integrated care due to system fragmentation and lack of reimbursement for non-traditional services.
Data and Patient Engagement in the Program
The study analyzed data from 123 Cityblock members in Washington, D.C., who participated in the program starting in April 2022. The average patient in the program was enrolled for approximately 10 months and received, on average, 2.3 interactions with care team staff per month. In addition, patients engaged in about two care planning activities per month, ensuring ongoing monitoring and adjustment of their care plans. The results of this program offer a glimpse into how consistent, integrated care in a behavioral health value-based care model can transform outcomes for high-risk patients—particularly those dealing with multiple health issues, including substance use disorders, mental health challenges, and chronic medical conditions.
However, while the results are encouraging, patient engagement did decrease over time. Researchers noted that one area for improvement moving forward is finding ways to maintain higher levels of engagement throughout the entire program. Consistent engagement is critical in behavioral health value-based care models, which rely on close, ongoing relationships between patients and their care teams to make necessary adjustments to treatment plans and ensure long-term success.
Cityblock Health: Expanding the Behavioral Health Value-Based Care Model
Cityblock Health, which is based in Brooklyn, New York, has expanded its operations to provide services in several states, including Massachusetts, North Carolina, Ohio, Illinois, and Florida. Through its behavioral health value-based care model, Cityblock provides comprehensive care to over 100,000 Medicaid and Medicare-Medicaid dually eligible beneficiaries, combining behavioral health, clinical care, and social care through a mix of virtual, in-home, and community-based treatment programs. Their programs aim to reduce reliance on emergency care and inpatient services, providing a more sustainable, holistic approach to patient care.
One of the key components of the Cityblock program, called the Advanced Behavioral Health (ABH) program, is its focus on providing access to a wide range of services, including injectable antipsychotics, medications for opioid use disorder (MOUD), care coordination, and social care navigation. Members of the program are assigned a dedicated care team, which includes a medical provider and a nurse care manager. These teams work closely with external providers to ensure that appointments are scheduled, medical equipment is ordered, and necessary resources such as food pantries are identified for the patient. These tasks, however, often fall outside the scope of what traditional Medicaid reimbursement models can cover under fee-for-service structures, leading to significant gaps in care.
The Flexibility of Behavioral Health Value-Based Care
Ruby Mehta explained the importance of this flexibility in care delivery, stating, “Behavioral health value-based care models allow for more flexibility in the services we can provide—from medical to psychiatric care, in-home services, community health workers, and more that traditional fee-for-service models don’t typically offer.” In other words, the fee-for-service model’s reliance on reimbursing individual services creates barriers to providing comprehensive, coordinated care that addresses the full spectrum of a patient’s needs. By contrast, behavioral health value-based care models incentivize outcomes rather than simply the quantity of care provided, allowing for more patient-centered, integrated approaches that address both medical and social factors impacting health.
Looking Ahead: The Future of Behavioral Health Value-Based Care
Since the pilot program’s launch, Cityblock has expanded the ABH program to all seven of its markets, further validating the success of its approach. This study is part of a growing body of evidence supporting the shift toward value-based care models. A 2023 study published in JAMA similarly found that behavioral health value-based care could potentially reduce mental health-related emergency room visits—another indicator that shifting from fee-for-service to value-based care can yield positive results across multiple sectors of healthcare.
The case for behavioral health value-based care models is becoming increasingly strong, especially as healthcare systems continue to struggle with rising costs and the need for more equitable care. By providing comprehensive, patient-centered care that integrates medical, behavioral, and social health services, behavioral health value-based care holds the potential to significantly improve patient outcomes, reduce unnecessary hospitalizations, and lower overall healthcare costs. As this study and others demonstrate, integrating these services and incentivizing positive health outcomes—rather than the volume of services—could be the key to addressing some of the most pressing issues in healthcare today.
Conclusion: A Path Toward More Effective Healthcare Delivery
As more providers, including Cityblock, continue to expand their behavioral health value-based care programs, the hope is that these models will become the standard, not the exception. If implemented on a broader scale, they could play a critical role in transforming healthcare delivery, particularly for vulnerable populations who have long faced barriers to accessing the care they need. The results from Cityblock Health’s study and similar research provide valuable insights into how a behavioral health care approach can bridge the gaps in care and create a more sustainable and effective healthcare system for the future.
