behavioral health

CMMI Focuses on Behavioral Health

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The Shift to Value Based Reimbursement Needs to Address Behavioral Health Access and Costs

CMS recently announced that the Center for Medicare and Medicaid Innovation (CMMI) is interested in lowering the cost of care for Medicare and Medicaid beneficiaries with behavioral health conditions while improving the quality of care and the overall access to care for those patients, and will convene a public meeting in the fall to discuss ideas to accomplish these goals. Notably, CMMI indicated that such a model may include participation by other payers, qualify as an Advanced Alternative Payment Model, improve health care provider participation in telehealth services, and address the needs of beneficiaries with care deficiencies in certain areas that lead to poor clinical outcomes or potentially avoidable expenditures, such as substance use disorders, mental disorders with comorbidities, Alzheimer’s disease, and/or behavioral health workforce challenges.  As we deal with an aging population and continue to confront the reality that clinical interventions account for only a small part of managing

Recent Developments in Patient Engagement and Healthcare Cost Initiatives

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In the wake of the recent flurry of commentary on the answer to the question of “What will happen to the Affordable Care Act?” the Commonwealth Fund released a new survey addressing how high-needs patients experience health care in the United States.  The survey underscores what many in the health care sector already know: that a small minority of patients (according to the survey, 10%), account for the majority (according to the survey, 65%), of healthcare spending in the United States.  The survey brings to light the ever-elusive question, the answer to which still remains unclear: how do we as a nation lower healthcare costs and improve population health?

The advent of high deductible health plans has helped employers shift some of the cost burden onto their employees in an effort not only to save money, but more importantly, to have their employees understand healthcare costs and encourage them to be better consumers.  Unfortunately, there is not only a lack of reliable data regarding