The Future of BHC is Quality

Consumers demand satisfaction. We want ease of access, ease of use, and we want it fast! Capitalism pays close attention to our demands and finds ways to meet them quickly. Amazon delivers many products same day. Groceries can be purchased from your phone and dropped at your doorstep. Service providers of any kind can be identified, evaluated, and engaged in real time.

But when it comes to healthcare, why do our demands for satisfaction go unmet?

There are a number of complex factors at play. One key component is that healthcare is a service we all need; at often and various times in our lives. When one needs care in an emergency, options are often limited (especially in rural communities). The demand far surpasses the supply, and this is especially the case in behavioral healthcare (BHC). When demand far surpasses supply, quality often drops.

BHC is a rapidly growing but immature sector within the healthcare landscape, wrought with deep systemic issues across all stakeholder groups. State and local government rarely have the funding to effectively regulate and ensure safe behavioral healthcare, payers haven’t finalized a formula for measuring and reimbursing for performance, consumers seeking care are in a highly vulnerable state, providers have to solve for patient acquisition, run their operations and attempt to get paid so they can stay in business. These, among many other factors, promote corner cutting and do not effectively reward quality.

If you’ve spent more than a day working in BHC, you know the patient harm and death toll is much higher than it should be. And everyone is responsible. This is why I write to you all. This is my attempt to demonstrate how quality care will elevate your organization and keep it in business. Most importantly, a collective alignment around quality will inevitably raise the standard of care and open up more access to those in need.

Payers will stop paying if you can’t demonstrate effective care

…and it is already happening. Many faucets have already turned off in our home state of Arizona. The payer calculation is simple: we pay for X to get a Y return.

Ask yourself: what kind of return am I delivering back to our payer(s), and where is the documentation that proves it?

Examples:

1) Insurance payer: if we pay for our subscriber to access mental health treatment (X), they’ll be less likely to need other medical treatments (Y) we would have to pay for.

2) Government payer: if we pay for our constituent to receive mental health treatment (X), they will be more likely to become or remain gainfully employed, contribute to the economy and pay taxes (Y)

3) Private cash payer: if I pay for myself or loved one to receive mental health treatment (X), I/they will have a better chance to flourish in life and contribute to my/our community (Y).

Quality care can be measured and demonstrated

How? Proper systems and processes for data collection.

1. Outcomes assessments - over the past 20+ years, evidence based batteries curated for specific populations in need have been developed and validated by physicians and clinicians to measure the effectiveness of treatment episodes in the form self reported symptom data. Example question: In the past 30 days, how much were you bothered by cravings or urges to drink alcohol or use drugs (BAM 2009)? Patients should always complete an assessment upon admission and on a consistent basis throughout their care and post discharge.
2. Employee engagement and retention - workforce stability has finally become a significant priority for BHC organizations. A rapidly changing roster of clinicians doesn’t bode well for organizations seeking to increase their reimbursement rates with payers. Without proper credentialing systems providers can lose their licenses which can lead to denials or even financial clawbacks. The workforce is shrinking and it is becoming increasingly difficult to attract and retain talent.
3. Critical incidents and sentinel events - preventing crisis events is not only in your company’s best interest, it is your duty as a provider organization. A committed approach starts with planning, data collection, policy creation, systems development, and training. These vital activities promote a culture of safety, prevent critical incidents and simplify the follow up process in the case of an adverse event. Improper documentation, or complete lack thereof raises the level of risk to potentially fatal for the organization.

Organizational leadership that invests in quality care are winning now and will win long term. Few companies in our industry have effectively adopted technology, systems and processes that deliver relevant data sets organizations can use to make decisions.

Above are a few brief examples that scratch the surface of this topic. In a series of articles and newsletters we at Simplifyance™ will continue to publish content on how your organization can establish these necessary processes and clearly demonstrate quality.