ADVERTISEMENT
Our Field Needs a Sharper Focus on Health Systems
People increasingly receive care within health systems, and experts are analyzing the ramifications. They are finding that this momentous consolidation of practitioners and facilities has led to “substantially higher” prices with marginal quality improvements. The behavioral healthcare field is part of this consolidation, and we should start focusing on how health systems will be shaping the future of our field.
There is no going back. We must improve health systems as part of improving care. Over 70% of hospitals and half of physicians now work in these systems. Behavioral health resources are steadily being acquired by them. While we have remained independent longer than most specialties, the expiration date for small scale solutions is approaching. Our innovators must start working on the scale of health systems.
Behavioral healthcare must immediately grapple with 2 issues related to health systems:
- As our isolated cottage industry transitions into large healthcare settings, more people will demand our services. Providing services at scale means adjusting them to the size of the problem encountered. This may mean having shorter clinical visits in the primary care setting. While psychotherapy is remarkably effective, we need new solutions for new challenges.
- Healthcare demands quality measurement, and our industry has lagged in this regard. We are fortunately witnessing substantial advances in measurement-based care (MBC) in recent years, and this should be our main quality improvement focus as we enter health systems. MBC has a lot to teach us about how a solution can evolve.
Start a Financial Dialogue
Our executives should prepare for the future by focusing on funding. Value-based care (VBC) is where healthcare financing is headed. Care may be more comprehensive with VBC insofar as funding will often cover the total cost of care. Health systems will be asked to manage and reimburse specialty coverage, including behavioral care. In short, health systems will operate as payers in many cases.
We should engage health systems now about funding because VBC could underfund behavioral care if other medical specialties gain priority status. A key goal of VBC is the reduction of total costs, and it is unknown how any system will achieve that.
Another potential financial issue should also be raised. Unlicensed behavioral coaches and counselors could one day become significant, unregulated competitors for therapists, and we should carefully monitor their growing use in primary care settings.
Our leaders should be strategizing to ensure health systems offer our clinicians an attractive new career path in healthcare. This will not come without a fight. For example, while health systems compensate their staff more highly than employers in our industry, these systems will probably be reluctant to increase behavioral salaries to achieve pay equity for similar jobs.
Many behavioral health clinicians prefer to stay immersed in their professional work without attention to these larger business trends. Many feel helpless when contemplating how their careers might be impacted, and they need behavioral executives to identify a rewarding path forward.
Technology-Enabled and Measurement-Based
MBC highlights how our field will be changed by new technologies and a broadening scope of accountability. Cottage industries are mainly accountable to clients. That scope is now widening to payers, health systems, and even includes social justice issues like health equity.
MBC started with researchers in small clinics, and now we have sophisticated companies selling MBC services. Early innovators embraced the clinician-client dyad as its scope. Today, clinical results are demanded by the public, executives, and payers, and MBC can meet these demands as the leading model of quality improvement for our field.
We should understand the evolution of MBC because it can serve as a paradigm for other advancements.
- MBC includes several components. The major scientific ones are psychometrics (for building valid tools) and statistics for analyzing results. Early analytics relied on cutoff scores. We now have benchmarking to give an expected trajectory of change based on the initial severity score and other characteristics.
- A core function—administering client self-report questionnaires and transferring data for statistical analysis—has evolved in sophistication over time. It is challenging for many reasons to depend on clinicians or office staff to administer and process forms. MBC cannot realize its full potential until this function is digitized to remove burden from all parties. New tech products propel this function.
- MBC provides its real value when feedback is provided, including actionable information to clinicians, clients, and executives. Clinicians learn which clients are off track and pose a risk for early termination of treatment or a poor outcome. Aggregated results can offer consumers and executives performance ratings (simple pass-fail may be best) on clinics and clinicians.
Core aspects of our field, including these features of MBC, will evolve over time. Let us recognize the pivotal role health systems will have in shaping our future. They will help determine our funding level, the demand and locus for our services, and our reputation as a quality-driven healthcare specialty. Yet no specific outcome is assured, and leadership will be critical in the next decade.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
