Just last week, the United States Department of Health & Human Services (HHS) announced that eight states have been chosen to participate in the Certified Community Behavioral Health Clinic (CCBHC) demonstration program (see HHS Selects Eight States For New Demonstration Program To Improve Access To High Quality Behavioral Health Services). The eight states—Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon, and Pennsylvania—were selected from 24 states that received planning funds from the Substance Abuse and Mental Health Administration (SAMHSA) last fall (see 24 States Awarded Planning Funds For Federal Certified Community Behavioral Health Center Demonstration). According to HHS, these eight states were selected because they “represented a diverse selection of geographic areas, including rural and underserved areas.”
These eight states have until July 1, 2017 to launch their demonstration, and HHS will begin reporting on the results of the program in December 2017. For the organizations that will be participating, there are six critical domains for organizational readiness and numerous required quality measures. These requirements were reviewed by Ms. Norris, J.D., senior knowledge engineer at The Echo Group at last month’s OPEN MINDS Technology & Informatics Institute, in her presentation, Treating For Outcomes Of Better Care: Understanding & Using The CCBHC Process To Managing Organizational Quality.
But if your organization is not in one of these eight states, is the CCBHC demonstration project relevant? With a new Presidential administration, there is some question about how the demonstration will move forward over the next few years, and if the program will be expanded as many hope after the demonstration ends. Are there strategic implications of CCHBC initiative?
I say the answer is a resounding yes – whether you are in one of the eight states selected to move forward with the CCBHC program or not. Why? The CCBHC program represents a trend that we see across all payers – value-based reimbursement with a requirement for specialists to coordinate services with primary care.
The CCBHC program offers states two prospective payment system (PPS) reimbursement options. In the first, CCBHC’s would receive a fixed daily reimbursement per visit, based on the federally qualified health center (FQHC)-approach, where payment is the same no matter the intensity of the services. In the second option, CCBHC’s would receive a fixed monthly reimbursement for every consumer who has at least one visit for that month (but do not get paid if the consumer doesn’t visit in that month). The CCBHC program’s care coordination requirements have been referred to as “the lynchpin” to the program (see CCBHCs 101: Opportunities and Strategic Decisions Ahead). CCBHCs will need to coordinate care across the spectrum of health services, including physical health, behavioral health, and social services; and will be required to form partnerships with other organizations, including FQHCs, inpatient psychiatry, detoxification and post-detoxification step-down services, residential programs, and social services providers.
These requirements are not unique to the CCBHC initiative. In fact, many payers are “out in front” on this evolution – from Medicare’s home health value-based purchasing initiative (see Medicare To Implement Home Health Value-Based Purchasing) and joint replacement bundled payment model (see Medicare Proposes Mandatory Cross-Setting Bundled Payment Model For Joint Replacements); to state Medicaid programs that are requiring managed care organizations to utilize value-based reimbursement for provider organizations (see Arizona’s Next MTLSS Contracts To Link 50% Of Payments To Value-Based Strategies and Georgia Medicaid Finalizes MCO Contracts With Amerigroup, Centene, Wellcare, & CareSource).
Whether your organization is in the CCBHC program or not, the “readiness” requirements are the same. Executive teams of specialist provider organizations should be thinking about how to develop new service lines with a business model that is compatible with value-based reimbursement. Service lines meeting that criteria will require partnerships with health plans, as well as investments in new technology infrastructure and staffing (see From Payer Vendor To Payer Partner and Four Keys To Success With MCO Contracting). When it comes to getting paid based on value, the performance metrics outlined in the CCBHC demonstration are a good place to start and give organizations an idea of what payers consider to be important (see Tackling The Thorny Issue Of Behavioral Health ‘Value’ and For All The Performance Measurement, Are We Really Measuring Performance?).
Even if the CCBHC program doesn’t move forward as planned, readying your organization for value-based care is a good investment for provider organizations looking to stay competitive in our changing market. For more on helping your organization make the transition to value-based reimbursement, see:
- Community-Based Providers In A Value-Based World
- Why Value-Based Purchasing Is Harder For Community Behavioral Health – And What To Do About It
- Remaining Profitable In The Transition To Value-Based Payment
- The Business Model Transition To Value-Based Care
For even more, be sure to check out our population health management series at The 2016 OPEN MINDS Performance Management Institute, including “Financial Management Of Value-Based Contracts: Preparing For Value-Based Reimbursement” featuring OPEN MINDS senior associate Ken Carr on February 16; and “Consumer Access & Customer Service Functionality In Population Health Management: Preparing For Value-Based Reimbursement,” featuring OPEN MINDS Vice President of Consulting, Paul Block, Ph.D. on February 17. For more detail on this can’t-miss series on preparing for value-based reimbursement, check out the entire institute agenda online now!
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