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Transition to Value Based Care (VBC) in Behavioral Health

Health care payers are increasingly shifting away from fee-for-service payment systems to Value-Based Payment (VBP) models that incentivize high-quality, cost-effective care. While increased access to and coordination of behavioral health services is a policy priority for federal and state policymakers, the manner in which a behavioral health system engages in a Value-Based Care solution is not well defined and is in various stages of implementation across the country.

Traditionally, the Electronic Health Record (EHR) is the source of all clinical information.  Patient information, diagnosis, care plans, service utilization, etc. reside inside of this solution. With increased focus on outcomes, homegrown measurement tools may have been developed internally or purchased outside of the EMR to track and measure patient outcomes.  Behavioral health clinicians have historically only been responsible for direct care and have limited understanding of contractual obligations and required measures/metrics.

Finance staff manages contracts with payers but use a separate financial system for accounting.   These two divisions (finance and clinical) operate in disparate data systems and segments within the organization. Data silos between clinical and financial staff are broken down to support the links between quality of care and revenue.

HR and Payroll encompass yet another data silo.  Staff time and cost for services must be tracked and calculated for services rendered, then matched up to the clinical records. Often there are more complicated payroll calculations needed because of the type of service, level of care or location in which it was delivered.

“Data and transparency are not seen as threatening but as critical tools that can help shape clinical service delivery that has the greatest impact.” – The National Council 

To obtain a big-picture view, all clinical, financial, HR, and outcomes data needs to be integrated to a centralized common data platform where it can be analyzed for cost and quality. From the data warehouse, core interactive dashboards with drill down capability allow review of the key performance indicators defined for your organization. Additionally, predictive analytics can be employed to identify data associations and strong relationships that aren’t visible to the naked eye.

A key element of a data warehouse is that any and all the data can be surfaced and captured for analysis. Robust business intelligence tools with self-service dashboards, reports, and analytics can empower your users with additional data insights and provide the ability to quickly answer data requests and monitor/measure contract performance.

The core requirements needed for a Value-Based Care solution:

  1. Integration of EMR, HR, Finance, & Data silos into single data repository.
  2. Master Patient Index tools to match patient records.
  3. Dashboards/Analytics for key performance indicators with drill down capabilities.
  4. Cloud-based solution requiring no additional staff, hardware, maintenance, or upgrades.
  5. Encounter-based integration that rolls up to Episodes of Care.
  6. Ability for easy data manipulation and visualization with self-service reports, dashboards, and analytics.
  7. Easy data exchange within health system or community partners.

A Value-Based Care (VBC) analytics platform will greatly improve the efficiency of the employees by reducing the staff’s time using manual data spreadsheets to calculate VBC metrics and assist the executive team with strategic decisions. Most important, it will provide the organization the VBC insight it needs to more efficiently operate its business and evaluate future needs in today’s ever-changing, Value-Based Care environment.

Would you like to learn more about integration and business intelligence tools to bring clarity to your organization’s data? Contact H4 Technology for a complimentary, no obligation demo.


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