Behavioral Health

Value-Based Payments: Easy to Envision, Difficult to Realize

Television and film provide a surprising glimpse into the past and future. Consider the much-loved Back to the Future, where Marty McFly travels to October 2015 from his cozy 1985 confines. In an unscientific way, I spent some time looking at the first few scenes in the movie’s fictitious 2015 to compare them with how life actually turned out. VBPs are payer-provider contracts structured to provide payment and/or incentives for better outcomes. Today, 95 percent or more of our provider contracts are in pay for volume fee-for-service structures (not VBPs). Our crystal ball writers would probably score 25-30 percent on future predictability, with the huge misses being flying cars; hoverboards (this one is close as there are self-propelled skateboards, they…

Read More

Time to Apply Behavioral Economics to Behavioral Health Care

The term “behavioral health” is about just exactly that – human behavior and its healthy alignment with the world. However, ironically, the very industry to improve behavioral health is way behind other industries in changing behavior. Consider the advertising industry: every day we are bombarded by sales tactics. Commercials on TV, ads on public transit, billboards on highways, grocery store aisle layouts, all of these add up to an all-out assault on our minds. Sometimes the target is our pocketbooks (think about the GEICO commercials); sometimes it is our actions (“smoking kills” campaigns in the 90s and 00s). Today, though, the tactics are more specific, focused, and nuanced than ever. The old-school way of behavior change was successful because it…

Read More

Medical Marijuana: An Oxymoron?

Has public opinion trumped the rigors of the scientific method – clinically sound research that supports or negates the efficacy of marijuana for medical use? A recent issue of the Journal of the American Medical Association (JAMA) devoted two extensive clinical reviews, a research letter, an editorial and a patient page to topics related to medical marijuana. The reviews lay bare what is at the heart of the medical marijuana debate for the health care industry: Has public opinion trumped the rigors of the scientific method – clinically sound research that supports or negates the efficacy of marijuana for medical use? There are downstream effects of the legalization of medical marijuana that are not specifically related to efficacy or safety….

Read More

If the Triple Aim Lost a Leg, Would It Still Stand?

The Triple Aim is an oft-cited health care mantra frequently invoked by health care’s informed clergy. A recent expensive demonstration project has produced outcomes that suggest one of its legs may be missing in action. It’s not the hoped-for result, but does it necessarily ring the death knell for the Triple Aim? Don Berwick and the Institute for Healthcare Improvement (IHI) coined the term in 2008 to serve as a pithy aspirational antidote addressing upward spiraling health costs and poor outcomes in the United States. The US ranks first in the spend category—total health care costs as a percent of GDP (17.1 percent). This statistic might not be an issue if our health outcomes matched the ranking. Unfortunately, we also…

Read More

Access to Behavioral Health Care Promotes Post-Traumatic Growth

Achieving positive psychological growth from adversity Behavioral health was an issue we avoided during my 20 years as an Army Infantry officer. It wasn’t until I began working for a national behavioral health company nine years ago that I understood the value of timely behavioral health care for our military. Through Chris Kyle’s story, America saw three key elements of behavioral health support that can lead not only to recovery but also to growth for an individual exposed to extreme physical and mental trauma, often referred to as post-traumatic growth. For many, that education came overnight. One recent box office hit gave more than 25 million Americans a realistic view of the importance of behavioral health support for the recovery…

Read More

Technology and Behavioral Health: The Time Is Now

Defining the Role of Technology in Behavioral Health Thanks to the myriad of new technologies entering the market, the opportunity to revolutionize health care delivery as we know it today is great! However, how do we know what really works and where to start prioritizing our efforts? As expanding access holds great potential to improve outcomes, we must include the use of mobile technologies in how we think about service-delivery models. The answer lies in Beacon Health Options’ new technology strategy: identifying specific areas and capabilities of focus. A rush to develop solutions Over the last decade, there has been an explosion of new technology solutions for promoting physical and mental health. These new solutions have included web- and mobile-based…

Read More

A Different Kind of Home under Construction: Behavioral Health Homes for the Seriously Mentally Ill

Over the past few years, health care reform has been buzzing with discussions about health homes. This new way of delivering health care is generating much enthusiasm among policymakers, payers, and practitioners. The goal, after all, is laudable: higher quality and lower cost, integrated care for more people. How do we provide care for our sickest patients at a cost we can bear? What does it mean to truly integrate care? At Beacon Health Options, we had the opportunity to apply our behavioral health expertise in support of this movement when we won a contract as the administrative services organization (ASO) for behavioral health homes in Connecticut. This contract was different work than what we had done before, and with…

Read More

Overkill: Unnecessary Care Is Low-Value Care

Solution lies in adhering to evidence that shows what works. Last month, Dr. Atul Gawande published a thought-provoking essay in The New Yorker about the millions of tests, drugs and surgeries that American people undergo every year, which won’t make them better, may cause harm, and costs billions. Sadly, this avalanche of unnecessary care is not confined solely to physical health care. Behavioral health and substance use disorder systems are also guilty of deploying what researchers call “low-value” care. This message is jarring, and the data indicating system failure is even more so. For example, only 25 percent of the 30 million Americans prescribed an antidepressant in a primary care setting every year show substantial clinical improvement. Given that common…

Read More