International Journal of Integrated Care (Aug 2019)
Where does the money come from? A U.S. Perspective on building the financial models towards Mental and Behavioral Health Integration.
Abstract
"Where does the money come from?" A U.S.A perspective of financing integrated health and value-based care including models under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), commercial payer contracts, grants, pay-4-performance, downside/upside risk and full capitation. In an ever-changing, regulatory compliance landscape where does behavioral and mental health services play a role in the various payment models? What happens when the providers must act as “payviders"? What kind of network topology is more efficient in quantifying value, reducing costs and improving outcomes? How to best build quantifiable bridges to payers and government programs to move towards value-based payments for government-sponsored behavioral health plans. How did we get here? - The origins of healthcare insurance and payment models in the United States Participants will discuss possible ways to collaborate with health departments and community organizations for an integrated approach of realizing return of investment. Participants will discuss how diverse funding models can be used to drive population health initiatives within a diverse network topology. Share strategies for how multi-system collaboration sets a culture of increase value and accountability. Highlight two behavioral health programs that address specific and prioritized needs identified within the community and engagement of various levels in population health initiative. Ways to identify a portfolio management of value based insurance design (VBID) to address multiple patient risks and quality gates. Understanding payer perspectives and approaches To value-based purchasing The movement away from fee-for-service has been a slow but steady journey towards value based reimbursement. This session will inform the audience on tackling the "tripe-aim" where payer and providers are creating an environment of convergence and collaboration. Addressing complex consumers and an ever-increasing cost models remains the main challenge for our current and future generations.
Keywords
