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Health plans in the United States are increasingly shifting away from traditional fee-for-service (FFS) reimbursement toward value-based care (VBC) models, which incent the quality of care as opposed to quantity. Although the promise of high-quality, cost-effective care is alluring, the adoption of and engagement in these programs has proven challenging for both plans and providers alike. Barriers include a lack of resources to support VBC programs, technology interoperability challenges, continuously evolving policies and regulations, unpredictable revenue streams and difficulty collecting and reporting data. Nonetheless, about half of reimbursements in the commercial sector are VBC reimbursements.
In contrast to physical health, mental and behavioral health are in a nascent stage of VBC adoption. Given that general healthcare spending is two to three times greater for patients with a mental or behavioral health diagnosis than for those without, care delivery models emphasizing efficacy and savings are particularly appealing.
There are compelling reasons for health plans to innovate in this area, despite the general complexities of VBC and barriers specific to mental and behavioral health.