Outcomes

First-episode Psychosis: Why Timing Is Everything and It’s Not Just Taking the Meds That Matters

One of my all-time favorite films is A Beautiful Mind starring Russell Crowe as the great John Nash, the genius mathematician who died earlier this year in a car crash. John Nash won a Nobel Prize in 1994 for his revolutionary work on game theory. He also struggled throughout his life with delusions secondary to paranoid schizophrenia. However, with the support of his wife and colleagues, he was able to learn to live and function despite the vicious persistence of his underlying psychopathology. On average today, people have psychosis for one year and five months before being treated. This timeframe is six times longer than the World Health Organization guidelines for effective early onset intervention (less than three months). The…

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Provider Calculus: How to Set Up a Staff Payment Model Under a VBP

Editor’s note: Jeremy Hastings, Beacon’s Vice President of Corporate Strategy, wrote a blog piece posted on Tuesday, Oct. 27, about how the future’s unknowns present challenges in building and implementing value-based payments (VBPs). His post this week follows up to describe in detail the inherent difficulties in setting up a single provider in a VBP. However, in spite of the hard work required to establish VBPs, it is not only possible, but also critical, to do. Value-based payments (VBPs) are one of the next frontiers for innovation in health care. In behavioral health, the innovation is coming, but inertia is a powerful force that needs to be overcome. Some of this inertia is entirely appropriate, as changing a decades-long reimbursement…

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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…

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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…

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