A Reflection on the rapid change in Mental Healthcare

As a Knowledge Partner with Open Minds, I recently attended the Annual Performance Management Institute in Clearwater, FL. I was curious about the attendees and various mental healthcare organizations that would be in attendance as this would be my first time at an Open Minds-sponsored event. After reflecting on my time (which I feel to have been very well spent) learning more about the behavioral health/substance abuse/human services landscape, the word that comes to mind is ACCOUNTABILITY.

The mental healthcare community is slowly but surely rising to the value-based payment level that the physical health world has been dabbling in for the past several years. What the mental health providers have as an advantage, however, is the ability to learn from the trials and tribulations that the physical health providers have overcome…or so I thought.

Accountability is being driven to the mental healthcare providers at full speed, but not all providers have the appropriate data to take on that responsibility and risk. For example, a mental healthcare center taking care of a patient with schizophrenia and diabetes is not being measured on drug adherence for schizophrenic quality measures alone. They too, would also be held accountable for things like HbA1c and retinal eye exams just like the physical health providers.

The overarching problem that I realized at the conference is that payers are no longer separating mental healthcare from physical health, but if the two health systems are still siloed, then how can they have leverage in negotiations with payers? Or know how they are performing to meet quality metrics? Or which providers need help in their effort to continuously improve to achieve the triple aim?

What is missing at the crux of these value-based payment contracts is the data.

Before contracting even begins, providers across all aspects of healthcare delivery need to know where the data will come from, where it will be housed, and what kind of insight the data can provide so that when they are asked to take accountability for performance, they already know how they will be measured, which metrics are appropriate for their organizations, and how they can access the data on a continuous basis.

Coming from a data driven organization, it was surprising to me that this piece was missing in these negotiations, but in retrospect, this may be the first time these mental healthcare organizations are revisiting their contracts since the early 2000s or earlier. For some, it may be the first time these organizations have even begun to think about how they will be fairly reimbursed for value instead of volume.

It’s an exciting time for everyone in the field because it is a massive overhaul; it’s all new!

But please, heed the warning: know your data and know what you have access to before starting negotiations in value-based payment because you are now accountable and the risk is on your shoulders.

Amy Kotch

About the Author


Amy Kotch, MHA

Amy Kotch is Salient’s Lead Business Consultant working with ACOs nationwide. She received a masters in health administration from Florida Atlantic University as well as a bachelors of science from the University of Miami and has just recently completed a master certification in population health through a federal grant from the Office of the National Coordinator for Health Information Technology in conjunction with the Johns Hopkins University and Normandale Community College. Her prior work includes being the operations coordinator at Triple Aim Development Group consulting with ACOs/MSOs.

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