A couple of weeks ago, a news release caught my attention – In Philadelphia’s Mental Health Clinics, Use of Evidence-based Therapies for Youth Psychiatric Treatment is Slow to Catch On, Despite Investments. The study from the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) in the City of Philadelphia and Penn Medicine found that investments in evidence-based practices resulted in a moderate increase (6%) between 2013 and 2017 in the use of cognitive behavioral therapy among clinical professionals serving Philadelphia youth.
What was that investment? In 2013, DBHIDS in the City of Philadelphia created the Evidence-Based Practice and Innovation Center (EPIC). The purpose of EPIC is to provide training and education on evidence-based practices (EBPs), contract specifically for services delivered using EBPs, and align fiscal incentives with the delivery of EBPs.
To learn more about the initiative and its effects on the health and human service field, I reached out to Geoffrey Neimark, M.D. Chief Medical Officer at Community Behavioral Health (CBH). CBH is the Medicaid managed behavioral health organization in Philadelphia and a key supporter of the project. Dr. Neimark explained that CBH was initially interested in EBPs for two reasons. The first was the belief that they had an ethical obligation to provide the best treatment possible to the individuals they serve. The second reason was that CBH has an obligation to the state and county to provide fiscally responsible care. Finally, Dr. Neimark noted that Philadelphia is lucky to be located in an area with a strong academic presence and the Beck Cognitive Behavior Therapy, which allowed for them to really embrace EBPs.
Through the EPIC program, CBH and its partners started providing training and education on evidence-based practices to individual clinical professionals. What they found was that this method was not effective for the dissemination of EBPs. Dr. Neimark explained:
That is a lesson learned, we focused initially on the training of individual clinical professionals and what we learned and what the data showed was that it’s equally if not more important to focus on the agency level. Clinical professionals might leave, they might be a lone practitioner in a desert of an agency. There needed to be agency-level buy-in and support. There needs to be a culture where it isn’t a one-off.
Dr. Neimark stated that they also realized that they needed to financially incentivize organizations to adopt EBPs. CBH initially covered the expenses associated with training of contracted clinical professionals in the various EBPs, but later realized they also needed to add in an enhanced payment for services that were provided within an EBP framework. By making a mechanism available for services performed that were in an EBP program, CBH was able to incentivize increased adoption of those services for its members. To receive the EBP rate (modifier), agencies need to be certified as an EBP organization which required them show EBP certification and training, have processes in place to identify individuals who are appropriate for EBPs, and have quality assurance processes in place for EBP delivery.
We also talked about the future of EBPs in general and what CBH has planned for the next couple of years. Dr. Neimark explained that one of CBH’s main goals is educating consumers on EBPs and helping them identify high-quality provider organizations. What form that will take the organization is working on, but they want consumers to ask for treatments by name-similar to the drug advertisements that suggest you discuss that specific drug with your physician. He also noted that there will be more interest in practice-based evidence, the concept of which will most likely evolve. Payers are also going to be more willing to pay for practice-based evidence. Payers and health plans are currently working on the best ways to reimburse these types of services. He remarked:
We see this as an opportunity. We pride ourselves on being transparent and open and this is part of that. We want that number to go up. I will also say that there is lag in the study data and it doesn’t reflect the change we made towards focusing on agencies and the agency certification. I will be interested in seeing what the data says about today. 6% is something; it’s not as robust as we would like to be, but it is something. It is a start in a field that has resisted change.
Dr. Neimark had a couple of pieces of advice for organizations looking to implement evidence-based practices in their organization:
I think really having executive leaders very prominently demonstrating and interested in EBPs is the single most important thing for adoption. Leaders need to both state its importance and reinforce the topic through other forms of communication. They also need to explain that it is part the fabric of the organization, and that the field is moving to EBPs. Leaders should also incentivize staff for the use of EBPs. Do you send around your leader boards on who is doing the most EBPs? Do you give a bonus for use of EBPs? It’s really important to the messaging to come up with levers that help recognize the people that are doing it. Leaders have to be part of it and supportive of it.
As health plans and stakeholders demand more value-based reimbursement and demonstration of quality, the use of EBPs is going to become more and more important – not only from a reimbursement perspective, but for the wellbeing of the individuals served. Provider organizations need to ensure that these practices are in place at their organizations sooner rather than later (for more see Implementing Measurement-Based Care-From Idea To Action, Behavioral Health Evidence-Based Practices As Population Health Management Tools, The Why & The How Of Clinical Decision Support, The Moving Target-Best Practices In ‘Complex’ Care Management, The ‘Best Practice’ Challenge).
And for even more, join us at The 2019 OPEN MINDS Management Best Practices Institute in Long Beach on August 14 for the keynote address, “The ‘Melting’ Value Chain: Defining Best Practice Management Models In An Era Of Change” featuring Monica E. Oss, Chief Executive Officer, OPEN MINDS.