A VBC approach to improving pediatric behavioral healthcare access

Reinvigorating the collaborative care model

The collaborative care model has existed for over two decades and demonstrated many benefits, particularly for integrating behavioral and mental healthcare. The American Psychiatric Association (APA) names this model as the most effective for integrating mental healthcare, citing positive results in spending control, access to care, patient outcomes and satisfaction, and other factors.

Despite these advantages, implementation has been fraught with challenges. Staffing demands, cultural differences between pediatric providers and behavioral healthcare providers, coverage complexities, and regulatory barriers present various hurdles for healthcare leaders looking to adopt the model.

CareFirst and Children’s National successfully used this model in their partnership to give psychiatrists a larger patient load and connect more members with behavioral healthcare providers, Oleg Tarkovsky, the former director of behavioral health services at CareFirst, explained to HealthPayerIntelligence.

Through collaborative care, young patients continue to see their pediatrician as their main healthcare provider. However, psychiatric prescribers may consult pediatricians on treatments for children with behavioral health needs. As a result of this model, a psychiatrist can transition from seeing only 300 patients to consulting on 3,000 patients, a move that may expand access to care.

In order to support providers’ involvement in collaborative care, Tarkovsky directed a team of around 25 clinicians to educate pediatricians on collaborative care for behavioral healthcare. These clinicians offer presentations on the model and provide their email and phone information so that interested providers can receive support. The team follows up with providers who implement the model.

“A lot of times folks actually give up on things like collaborative care models because it's not that easy to set up,” Tarkovsky acknowledged. “So, we have a team that helps any group that wants to implement some of these measures regionally and nationally to see it to fruition and not just talk about it.”

Integrating solo behavioral healthcare providers into MSOs

Including independent behavioral healthcare providers in payers’ networks is crucial to giving members access to care. However, these providers often lack amenities that make it easier to work with payers and connect with patients. For example, some independent practices do not have their own websites, online scheduling systems, or billing offices.

CareFirst encouraged solo behavioral healthcare providers to join the payer’s managed services organization (MSO). The MSO offers a website and better searchability.

Behavioral healthcare providers seem open to the shift. Wheeler reported that over 800 behavioral healthcare practitioners were in the managed services organization.

As a result of MSO adoption, members can find providers more easily. Also, they can see more information, allowing them to be more selective such as choosing a provider based on cultural competency. There are more appointment time slots available in the MSO’s online scheduling system, so that members can access behavioral health treatment more quickly.

“It's all about organizing things in a way that people can find them and then making sure it's easy to connect,” Wheeler said.

As with the collaborative care model, Tarkovsky’s team educated providers about how to set up digital referrals through the MSO. Typically, it can take less than five work days for members to connect with a behavioral therapist through this digital system.

Applying value-based care to pediatric behavioral health

The hospital and payer found that applying a value-based care model to their solutions would lead to better outcomes. Children’s Health approached CareFirst with an incentives model that could work with a fee-for-service chassis.

In this model, CareFirst increased its fee schedules for a few categories of services to financially incentivize providers to take steps that would improve pediatric behavioral health.

First, it boosted the fee schedule for pediatric wellness visits. While not directly related to behavioral health, regular wellness visits provide the opportunity to catch mental health and behavioral health conditions early in a child’s development. They also decrease the number of sick visits and emergency department visits, Wheeler added.

Second, CareFirst incorporated incentives for providers to bring therapists into their contracts. The payer increased the fee schedule for practices that hired therapists who could address pediatric behavioral healthcare needs.

Third, the payer increased the fee schedule for certain screenings. Many children with mental and behavioral health conditions remain undiagnosed, which could produce worse health outcomes both as children and when they become adults. Improving payments for screenings is a common strategy in value-based care to support preventive care.

Lastly, if providers exceeded their goals, CareFirst offered additional incentive payments. The providers set affordability and quality of care targets for the entire pediatric population. At the end of the year, they may qualify for bonuses from CareFirst if they have achieved those aims.

“What we've seen is that Children's has done the work to work with those [behavioral healthcare] practices in this clinically integrated network to drive at these better results. They’ve got a good governance model and so we're seeing positive progress there,” Wheeler said. “We're optimistic that this is a good economic model for funding pediatrics in our communities.”