Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment

DISCUSSION: A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models.IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends.IMPLICATIONS FOR HEALTH POLICY: For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this as early as possible. Funders also need to collaborate with providers early in the grant period on sustainability planning for the post-grant environment. For payers, a key lesson is the need to fold novel models into stable existing funding streams such as Medicaid and commercial insurance coverage, rather than leaving them at the mercy of revolving time-limited grants, and to provide pathways for contracting for innovations under new payment models.IMPLICATIONS FOR FURTHER RESEARCH: For researchers, a key recommendation would be to pay greater attention to the payment environment when designing new delivery models and interventions.PMID:...
Source: Journal of Mental Health Policy and Economics - Category: Psychiatry Authors: Source Type: research