Accountable Care Organizations & Health Homes: Partnerships for Behavioral Health
With private and public payers' growing awareness that they are spending enormous sums for poor outcomes, new service delivery models have been developed to address the healthcare system's problems with quality and cost. Of these models, health homes and accountable care organizations (ACOs) are likely to serve as foundational elements of healthcare's future. Pilot efforts have demonstrated the potential of these models to improve quality while reducing costs. Increasing numbers of payers and providers are investing in them, and health reform's promotion of them will further accelerate their adoption.
Health homes and ACOs are responsible for providing the full range of healthcare services for the populations they serve. A 2009 report described a person-centered healthcare home as one that is equipped to care for the whole patient and manage multiple, interrelated and chronic health problems. Through new payment mechanisms, these homes will align their clinical and financial incentives to meet the triple aim of improved quality, patient experience, and reduced costs. Neither health homes nor ACOs will be able to reach that goal without effectively addressing mental health and substance use (MH/SU). MH/SU providers must determine what kind of relationship they want with these entities and what they need to do to qualify as partners.
To ensure their readiness to participate in health homes and ACOs, MH/SU providers are urged to undertake the following action steps:
1. Prepare now for participation in the larger healthcare field
2. Establish credentials as a high performer relative to the triple aim
3. Ensure information technology readiness
4. Plan for an extended period of change
National mental health care organizations work to support MH/SU providers' development in these areas through educational materials [http://www.thenationalcouncil.org/cs/resources_programs], webinar series, learning communities, trainings, consultation programs, and its annual conference.
With their focus on effective, coordinated care for the whole person, health homes and ACOs hold the potential for significantly improving the health and wellness of those they serve, including people with serious MH/SU conditions. Access to effective MH/SU services will be critical to the effectiveness of both ACOs and health homes. Regardless of the Affordable Care Act's ultimate fate, health home and ACOs will be foundational elements of the future healthcare system, and MH/SU providers must immediately begin positioning themselves to be recognized as qualified partners.
Health homes and ACOs are responsible for providing the full range of healthcare services for the populations they serve. A 2009 report described a person-centered healthcare home as one that is equipped to care for the whole patient and manage multiple, interrelated and chronic health problems. Through new payment mechanisms, these homes will align their clinical and financial incentives to meet the triple aim of improved quality, patient experience, and reduced costs. Neither health homes nor ACOs will be able to reach that goal without effectively addressing mental health and substance use (MH/SU). MH/SU providers must determine what kind of relationship they want with these entities and what they need to do to qualify as partners.
To ensure their readiness to participate in health homes and ACOs, MH/SU providers are urged to undertake the following action steps:
1. Prepare now for participation in the larger healthcare field
- Identify community partners and build relationships, especially with primary care.
- Develop competency in team-based care and health homes in particular.
- Institute a measurement-based approach to care, incorporating standardized clinical assessment tools into routine service delivery.
- Gather data on population served in order to support recognition as a "high-volume" specialty provider.
- Increase skills and knowledge in population health management, including wellness and prevention and disease management approaches.
2. Establish credentials as a high performer relative to the triple aim
- Adopt quality tools and train staff in using them to track performance.
- Assess clients' experience of care (including its patient-centeredness and cultural/linguistic competence) and address gaps.
- Document MH/SU and general health outcomes (e.g., body mass index) and implement a plan for improving areas of weaknesses.
- Evaluate the cost and value of the care provided.
3. Ensure information technology readiness
- Institute IT systems that are able to support:
- Reach out to community partners to begin forming local or regional health information exchanges.
- Exchange of data within and outside the organization
- Use of data as a routine part of clinical work
- Performance review practices
- Management of new payment structures (including linking performance to payment)
4. Plan for an extended period of change
- Implement a change management plan.
- Identify key resources and support network for staying current around new and emerging practice and financing models.
- Invest in educating board and staff on operational and clinical changes
National mental health care organizations work to support MH/SU providers' development in these areas through educational materials [http://www.thenationalcouncil.org/cs/resources_programs], webinar series, learning communities, trainings, consultation programs, and its annual conference.
With their focus on effective, coordinated care for the whole person, health homes and ACOs hold the potential for significantly improving the health and wellness of those they serve, including people with serious MH/SU conditions. Access to effective MH/SU services will be critical to the effectiveness of both ACOs and health homes. Regardless of the Affordable Care Act's ultimate fate, health home and ACOs will be foundational elements of the future healthcare system, and MH/SU providers must immediately begin positioning themselves to be recognized as qualified partners.