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How to Pursue Behavioral-Physical Healthcare Integration in a VBC Framework

Instituting behavioral-physical healthcare integration requires change for many stakeholders, but in a value-based care framework it is possible.

behavioral healthcare, value-based care, mental healthcare

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By Kelsey Waddill

- When MetNetOne Health Solutions established roaming physician teams that would go from practice to practice to help address chronic disease management needs around two decades ago, it became apparent that something was missing. The teams lacked a behavioral healthcare specialist.

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From that realization, the organization developed its strategy around integrated behavioral and physical healthcare, which MedNetOne Health Solutions continues to prioritize. Early on, the organization’s medical director invited behavioral healthcare specialists to join his practice and to practice in the same building. The organization watched no-show rates drop as a result.

“To me, any practice that is new or any practice that's beginning to move into value-based contracting, it's crucial for that organization or that practice to begin to investigate the best way in which to collaborate with the behavior health specialist, integrate that behavior health specialist, or have a mechanism in place where there will be access to one by their patient population,” Ewa Matuszewski, chief executive officer and co-founder of MedNetOne Health Solutions, told Healthcare Strategies.

While fusing physical and behavioral healthcare within a value-based care system seemed effective for MedNetOne Health Solutions, it came with certain challenges. Primarily, the organization had to assess how to collect copayments.

“If both clinicians were seeing a patient at the same time and they had a co-payment, I had a behavior health person that was collecting the co-payment, and then I had a primary care physician that was collecting that co-payment as well,” Matuszewski explained.

State funding and payer funding helped the provider resolve this issue. But when a payer refuses to fund the services, Matuszewski’s practice shows the payer the data.

“If there isn't payment made by that payer, we will go after that payer by simply saying, ‘because of the work we're doing, the ED admission or the ED use of that patient has decreased by X, the readmission rate has decreased by X, the urgent care use is decreased by X. So don't you think it's logical for you to be paying for the services that we are providing?’” Matuszewski shared.

Based on the practice’s experience, Matuszewski offered recommendations to other stakeholders who are trying to integrate physical and behavioral healthcare within a value-based care framework.

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