Funder: Centers for Medicare & Medicaid Services
Author: Melissa Bailey, Rachael Matulis, Kelsey Brykman, Center for Health Care Strategies
September 2019 | Report
Health care payers are increasingly shifting from fee-for-service payment systems that reward volume to adopt value-based payment (VBP) models that promote high-quality, cost-effective care. While increased access to and coordination of behavioral health services is a policy priority for federal and state policymakers, the extent that the behavioral health system is engaged in VBP is less well understood than its physical health counterpart. In partnership with the National Council for Behavioral Health, the Center for Health Care Strategies (CHCS) conducted interviews with representatives from behavioral health associations, community-based behavioral health providers, state agencies, Medicaid managed care organizations (MCOs), and other subject matter experts to understand the successes and challenges associated with implementing VBP in Medicaid behavioral health care.
Informed by these interviews and a review of state program guidelines, quality measures, and MCO contracts, this report provides: (1) an overview of the behavioral health system’s engagement in VBP in the U.S., with a focus on 11 states; (2) lessons on implementing VBP from the perspective of behavioral health providers; and (3) policy recommendations for how state and federal policymakers, MCOs, and other stakeholders can support the adoption of VBP within behavioral health care. It also identifies nine key themes that support successful behavioral health VBP design and implementation to inform efforts in states across the country.