Greetings from Albany, where I had the opportunity to deliver the opening keynote, Health Care’s Value-Based Environment: Strategies For Behavioral Health Organizations In New York, this morning at the Behavioral Health Value Based Payment Conference. Hosted by the New York State Office of Mental Health and Office of Alcoholism and Substance Abuse Services, the Health Foundation for Western and Central New York, and the Managed Care Technical Assistance Center. The conference had one main goal — to prepare community-based behavioral health organizations for success in a system moving towards value-based payment. The state’s goal is to have 90% of their Medicaid managed care payments in value-based payment arrangements by 2019 (see The State Of Medicaid In New York: Progress And The Road To Value-Based Payments, In shift to value, a chance for New York’s Medicaid to transform healthcare for children, and Behavioral Health The Focus of 22% Of New York DSRIP Proposals). A tall order in a short period of time.
While there are many challenges for community-based organizations (CBOs) in making this transition, I think the most fundamental challenge is developing a strategy to fund services that fulfill the organization’s mission and incorporate value-based reimbursement. The first step in this process is understanding what new service options exist. Our team at OPEN MINDS has developed a pretty extensive inventory of the “possibilities” of new CBO roles with health plans, accountable care organizations (ACOs), health systems, and primary care programs. There are many options – subcapitated service delivery, specialized care coordination, management of acute episodes, consultation to acute care and primary care, preventing admissions and readmissions, and specialty primary care.
But great service alone is not enough – any new service line needs a new business model and a health plan/ACO with sufficient volume for on-going sustainability. When making these fundamental strategy decisions, leadership teams should ask themselves these three questions:
Fortunately, there are a lot of opportunities for CBOs to consider. Unfortunately, there is no right answer to this strategic puzzle – organizational competencies, the payer landscape in the service area, competitive program offerings, and organizational assets (both human and financial) are part of this complex equation.
The place to start is by understanding your environment, your payers, and your consumers. To get a better grasp your market, check out the landscape and players in our service of market intelligence reports. I recommend:
The Changing Medicaid Carve-Out Market: The 2016 OPEN MINDS Update On Vertical Carve-Outs: This report includes an analysis of each state’s Medicaid behavioral health managed care model, including a look at states with specialty health plans and the number of consumers enrolled in each state.
The 2016 OPEN MINDS Medicaid Managed Care Update: A State-By-State Analysis: This report includes a state-by-state look at managed care, fee-for-service, and primary care care management (PCCM) enrollment – including historical enrollment data.
Medicare Specialty Plans For Dual Eligibles: The 2016 OPEN MINDS D-SNP Report: This report includes a list of the Special Needs Plans for dual eligibles (D-SNP) available in each state, including enrollment.
How Many Foster Care Children Are Enrolled In Medicaid Managed Care?: An OPEN MINDS Market Intelligence Report: This report includes a review of which states require children in foster care to be enrolled in Medicaid managed care, which states are planning to move foster care children to managed care in the future, and the number of children in foster care enrolled in Medicaid managed care in each state.
What Are Medicaid Waivers & Why Do They Matter?: An OPEN MINDS Market Intelligence Report: This report includes a list of the waivers that are currently active in each state, each state’s pending waivers, and the populations served, waiver caps, and waiver expiration dates.
To listen to my full talk click here. And to learn about how behavioral health provider organizations are using technology to adapt in a value-based market, join me on November 11, in Washington, D.C. for my keynote address, Forecasting The Future: What’s Next For Health Care Technology?, at The 2016 OPEN MINDS Technology & Informatics Institute.