Behavioral health needs, but isn’t ready for, value based payment
This post is part of a series of takeaways from working in the behavioral health space over the past year
With Medicaid expansion and the (slow) implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA), reimbursement for addiction treatment has shifted over the last decade from the Substance Abuse and Mental Health Administrations (SAMHSA) block grants to fee-for-service (FFS) reimbursement. The shift for providers was not only financial but also cultural. Addiction treatment providers have only recently warmed up to the consistent but regulation-riddled FFS model. They both lamented and rejoiced at the loss of the flexible but limited ration of annual block grant dollars.
While addiction treatment was learning to crawl in FFS, somatic care was relatively sprinting, with sprained ankles an all, away from FFS and toward value-based payment (VBP). With carrots and sticks from the The Patient Protection and Affordable Care Act (PPACA) and the Medicare Access and CHIP Reauthorization Act (MACRA), Medicare providers were pulled and pushed toward category 2, 3, and 4 alternative payment models (APMs).
Medicaid-reimbursed addiction treatment is 5 to 10 years behind Medicare-reimbursed somatic care in its journey toward VBP. Despite the recent Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act requiring Medicare to reimburse opioid treatment programs, there are very few legislative and regulatory mechanisms to incentivize the shift from FFS to VBP in addiction treatment.
Even if the addiction treatment industry autonomously pursues VBP, as some progressive payers are contemplating, providers are not yet ready for that transition. Medicare providers, even with all of their government-funded technical support, are still kicking and screaming nearly a decade into their transition to VBP. Medicaid-reimbursed addiction treatment providers are generally less well resourced and deal with more socially complex patient populations than Medicare-reimbursed providers of somatic care. Additionally, the quality measurement frameworks for addiction treatment are still in their infancy, so it is hard for payers to put at financial risk what they can’t measure.
Several promising projects are underway to accelerate addiction treatment toward VBP. But that pace needs to significantly pick up if we’re going to meaningfully save lives at an affordable cost.
Next post: Behavioral health software is ripe for disruption
