Models of Care that are not Inclusive of Behavioral Health: Making the Shift to Integrated Care

Results from the Centers of Medicare and Medicaid (CMS) on Accountable Care Organizations (ACO) showed mixed results and an overall failure to capture significant savings. Only 21 ACOs applied and have been designated as the Next Generation ACO from a pool of 353 ACOs designated as Pioneer in 2015. While the list of providers in this performance value-driven care model whittles down to the potentially “best and the brightest”, a primary question remains: “How is integrated care really implemented to show cost savings and performance impact?”

With models of care like the Pioneer and the Next Generation (and even the NY DSRIP) still centered on medical disease and disorders as the primary diagnosis, the continued impact of these change models still will not address the need for integrative care. With 50-70% of avoidable admission encounters for emergency rooms and emergency departments driven by patients with a primary diagnosis of behavioral or substance use, delivery systems need to build care models that address these integrated health needs and allow behavioral health to be blended into treatment approaches as a primary indicator of health and service need.

Planning for an integrated care model also requires planning an evaluation design that captures these necessary performance values. Linking treatment outcomes to the required performance HEDIS measures is not indicative of optimal clinical outcome, particularly as the performance measures minimally include behavioral health values and social determinants. For example: measuring health literacy and adherence to motivation and engagement is needed but often this is lacking in the planning of integrated care. It’s important to change the perspective and delivery model of medication to better adherence. Measuring these intervention models requires thoughtful and integrative evaluation solutions.

For more on the necessity of Evaluation Designs, click here!

The need to address population health has never been more pressing. Providers must show value in treatment outcome while building the infrastructure to grow a financially viable systems of care. While the year is just starting, the march to Population Health continues and SAE is committed to being a change agent in this process.

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