Value-Based Payment Systems

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DoctorThe term ‘value-based payments’ is being thrown around a great deal in the behavioral health industry. It describes a new method of paying for healthcare that encourages providers to give each patient the best care possible. Currently, healthcare providers are paid for their services based on the number of patients they bring in the door, as opposed to the quality of care they provide. With value-based payments, providers are assessed on the care they give and are given incentives to improve their metrics. This system is currently being tested by a number of payers and providers, but it has not yet fully expanded to behavioral health.

Of course, the transition from fee-for-service payments to value-based payments has not been easy, and there are still many undetermined factors at play. The healthcare system has relied on a volume-based payment program for so long that the rough transition surprises no one. There was, initially, the issue of tracking performance. Metrics with which to measure the quality of a provider’s care had to be agreed upon. Currently, it looks as if many of the value-based programs are using inpatient quality reporting data. Part of the issue with expanding value-based payment programs to behavioral health is that quality may be more difficult to track in behavioral programs. Unfortunately, the measurement of metrics for value-based programs that are now present do not apply to behavioral health.

Another difficult transition is the shift in provider tracking. Instead of accounting for insurance companies and patients as if they are all the same, the care of all patients must be scrutinized individually. Providers have to compile evidence that they are meeting or exceeding standards for quality care at the lowest cost possible in order to get rewards for their hospital.

Despite the difficult transition from the old way of payment, it is speculated that a shift to value-based payment has the potential to improve the behavioral health industry as a whole. It will, for one, encourage behavioral health providers to give their patients quality, low cost care. Insurance companies typically do not offer reimbursement for mental health services, as they treat it as being separate from physical health services. Switching to a value-based program would change that. It would give insurance companies an incentive to cover more mental health services, a phenomenon that is woefully lacking today.

Overall, value-based payment systems are being heralded as the future of this country. They are looking to completely change the healthcare industry by focusing more on patient care that saves money in the long run by making sure there is less hospital readmission and costly care. While this is beneficial for medicine as a whole, it will have the biggest impact on behavioral health.

For more information, visit New Horizon Counseling Center.

 

Mental Health, Worldwide

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HandsWhile mental health is an issue being pushed to the forefront of American culture, it is still not recognized everywhere in the world. Many societies refuse to believe in mental illness, and therefore shun anyone who exhibits signs of a disorder. Other places tend towards things like demonizing the suffering individual and hiding them away from their peers. It is an unfortunate practice, as those who need help are not getting it. This is especially true in underserved countries and for people like refugees. It is no wonder in such places that mental health professionals are hard to find, but it is in dire situations that such professionals are necessary. This is why the World Health Organization and the World Bank have decided to move mental health on to their global agenda.

The two groups recently met in Washington to discuss the state of mental health in the world, and realized that it was an untreated epidemic in many places. Refugee communities especially are suffering. People in such communities are forced to leave their homes, and tend to suffer from psychological distress as a result. Many refugees suffer from post-traumatic stress disorder, depression, and anxiety. Mental health counseling would improve the quality of life immensely for individuals in such situations, yet nobody has thought to act on the fact until now.

Apparently, this recent decision by the World Health Organization and the World Bank came at the same time as a release of research on investment opportunities for depression and anxiety treatment programs. The research showed that investing in these programs could have a sizable return, making it a high gain investment without much risk involved. This conclusion is based on other worldwide treatments that have been successful in the past. A tool called OneHealth was used to estimate the cost and return.

Mental health has not been entirely absent from the developing world, however. In the past, individual groups have attempted to raise awareness of mental health to underserved populations. Mental health workers have traveled to countries ravaged by disease or natural disaster in an attempt to help the people in the midst of crisis. Individual aid groups have also developed treatment programs for women and men who have suffered some kind of sexual abuse. However, mental healthcare in developing countries has never been taken on by well-known health organizations. This could be a giant step forward for the mental health community worldwide.

While it is unclear how much this focus on mental health was spurred by a potential return on investments, spreading mental health care to refugee communities and developing countries is important. It will improve the quality of life all over the globe, and signifies another step toward eradicating the stigma surrounding mental illness for good.

Study Shows Mental Health not a Priority Amongst General Practitioners

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The_Doctor_Luke_Fildes_cropAlmost one in five Americans suffer from mental health conditions. According to studies reported by News Week, approximately 42.5 million Americans, or 18.5 percent of the American population lives with some form of mental illness such as depression, bi-polar disorder, and schizophrenia. The same report accounts that 9.3 million of those adults – ages 18 and upward – suffer from “serious mental illness”, disrupting their ability to carry out day-to-day tasks. Problematically, the American mental health care system is ill-equipped to treat many, if not most of these individuals.

Rising scrutiny over the American mental health system has brought to light many inadequacies among general mental health care. For example, many individuals displaying mental illness symptoms seek the help of general practitioners. However general practitioners – although qualified – fail to either properly diagnose or treat mental health. Other conditions that affect physical health are often prioritized and even valued more than those affecting mental health. The Huffington Post reports that doctors often neglect to follow-up with patients displaying symptoms of mental illness. Contrary to that, doctors are much more likely to engage with patients suffering from chronic physical illness. What does this mean? The report found that doctors are actively partaking in treatments for patients suffering from diabetes, heart failure, and asthma, but not for those suffering from mental issues like depression.

Part of the reason for this failure is the general cost of health care. Most individuals suffering  from mental illnesses like depression or bipolar disorder are left out of proper treatment for financial reasons. Specialists are often expensive, and treatments and visitations are not covered by average health insurance packages. General practitioners who are largely unfamiliar or ill-equipped to treat mental conditions do not address the issue with the attention it requires. “Depression is a recurring illness. When it’s there, it’s often present for months. It needs a lot of active management and multiple treatments. Most people can recover from their depression, but they’re vulnerable to a second depression or a third depression,” said Sagar Parikh, associate director of the University of Michigan Comprehensive Depression Center.

The stigma surrounding mental health illness may also be a contributing factor to inadequate treatments. Doctors may just deem physical ailments as more deserving of treatment, rather than spending time and effort with mental conditions. This may lead to improper doses of possibly harmful medicine. If general practitioners and doctors saw mental health with the same urgency as physical health, many more cases would be properly treated. Mental illness like depression and bipolar disorder lead to other more harmful conditions, such as cardiovascular disease, gastrointestinal issues, and strokes.

Lindsey Holmes of the Huffington Post believes that changing cultural attitudes towards mental health disorders may lead to more adequate training for doctors and treatment for individuals. “These illnesses require effective treatment and proper care in order to live a fulfilling, healthy life,” ends Holmes.

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A Different Kind of First Aid

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ISO_7010_E003_-_First_aid_sign.svgWhen many think of ‘first aid,’ a visual of one person putting a bandage on another may come to mind. First aid is usually deemed appropriate when a person suffers some sort of wound. However, mental health is not associated with first aid. On the contrary, mental health is not considered a condition that can be treated in any specific moment; you cannot put a bandaid on someone’s emotions. Nevertheless, the National Council for Behavioral Health has created a mental health first aid course, in which people can learn skills such as how to react appropriately when they believe someone is adopting a mental health issue, and what to do when someone is in the midst of a mental health crisis.

It is astounding how much of the population does not know how to properly react when witnessing the manifestation of a mental health disorder, considering that 1 in 5 persons experience some degree of mental illness each year. Instead, the level of mental illness stigma is rising at an alarming rate because people distrust what they do not understand. Mental health first aid is meant to be a resource for those who have never experienced mental illness to understand the different experiences people with mental illness may have, and how to appropriately react to said experiences. It is, therefore, educating its students and combatting stigma by default.

This course is not simply about lending an ear to someone in need. Rather, it is geared toward all types of tough emotional situations. In 8 hours, its participants are taught about common mental disorders and are made to memorize acronyms for and action plan to react to someone experiencing a mental health crisis. It becomes painfully clear during the training that everyone experiences mental illness differently, and no situation will be as clear-cut as is stitching up a wound. However, the steps taught in the course can, for the most part, be applied to any situation for a short amount of time. Instructors stress that the course teaches an immediate response and is not applicable to longer-term mental health care. When someone is experiencing a mental health crisis, he or she needs assistance right away. However, longer term mental health care should be taken to the professionals.

The step-by-step reaction process is memorized through the acronym ALGEE. It stands for Assess (the situation for risk of harm,) Listen (without judgment,) Give (reassurance,) Encourage (professional help,) and Encourage (other support strategies, including self help.) Of course, not every step can be applied to every crisis, just as not every band-aid is shaped to fit every cut. However, the training stresses that the approach does not have to be in-depth to assist someone in need.

Mental health first aid was created as a program in 2001, and continues to grow. It is a resource that works toward the destigmatization of mental illness, and has the potential to help minimize the number of people who damage themselves during a mental health crisis. Hopefully, this training continues to expand and grow across the world.