Behavioral health pilot aims for value over volume

DENVER - Integrating mental health and behavioral health within the primary care setting unlocks a value proposition that benefits everyone, industry experts say.

Rocky Mountain Health Plans (RMHP) recently announced its role in a pilot project aiming to integrate behavioral healthcare services into the primary care setting. The local health system in Grand Junction, Colo., has been nationally cited for effective use of the medical-home model.

According to Benjamin F. Miller, Psy.D., assistant professor at the University of Colorado Denver School of Medicine, more mental illness is seen in primary care than any other setting. It's an industry reality that as much as 50% of outcomes and future costs are attributable to patient behavior.

"By better enhancing the integration of mental health and behavioral health within primary care, you singlehandedly tackle some of these issues," says Miller.

The pilot's main focus is to dismantle care silos and change the volume-driven system to a value-driven system. Behavioral health treatments aren't reflected in the Current Procedural Terminology (CPT) billing structure.

"Even if they were, the system itself is so crushingly dependent on volume that volume crowds out the activity that would otherwise produce value," says Gordon.

RMHP will reimburse providers on a risk-adjusted basis and will also reimburse for non-encounter services. Pilot participants expect to drive the model throughout primary care, regardless of the payer.

"This is essentially development capital being made available to advanced primary care practices within our region," Gordon says. "Rather than another grant program or a simple pilot, we're actually relating on an actuarial basis the value of the interventions and the impact they'll have on the trend and total cost of care."

With this type of modeling, Gordon says, it's possible to more than offset the cost of new payments and be in a position to share savings with providers, employers and the government. He says the participants are using an academic process to study the results of the three-year test.