Qualifacts + Credible Named 2022 Best In Klas: Software & Services

GETTYSBURG, Pa. (February 20, 2022) — Qualifacts + Credible, a leading provider of electronic health record (EHR) platforms for behavioral health and human services organizations, today announced the Credible platform has ranked No. 1 in the 2022 Best in KLAS: Software and Services report.

Additionally, Qualifacts + Credible’s CareLogic EHR platform is ranked No. 2 in the 2022 Best in KLAS: Software and Services report.

The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide.

“We are honored by the trust our partners place in us every day, and their success is our highest priority. This recognition from KLAS is a great validation of the remarkable work our teams have done in support of our mission to be an innovative and trusted technology and solutions partner, said Paul Ricci, chief executive officer at Qualifacts + Credible.

“Each year, thousands of healthcare professionals across the globe take the time to share their voice with KLAS. They know that sharing their perspective helps vendors to improve and helps their peers make better decisions. These conversations are a constant reminder to me of how necessary accurate, honest, and impartial reporting is in the healthcare industry. The Best in KLAS report and the awards it contains set the standard of excellence for software and services firms. Vendors who win the title of Best in KLAS should celebrate and remember that providers now accept only the best from their products and services. The Best in KLAS award serves as a signal to provider and payer organizations that they should expect excellence from the winning vendors,” said KLAS CEO Adam Gale.

About Qualifacts + Credible   
Qualifacts + Credible is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement. The company offers several EHRs – CareLogic, Credible and InSync – while collaborating to build an even brighter future for partner agencies and their clients.

About KLAS
KLAS has been providing accurate, honest, and impartial insights for the healthcare IT (HIT) industry since 1996. The KLAS mission is to improve the world’s healthcare by amplifying the voice of providers and payers. The scope of our research is constantly expanding to best-fit market needs as technology becomes increasingly sophisticated. KLAS finds the hard-to-get HIT data by building strong relationships with our payer and provider friends in the industry. Learn more at klasresearch.com.

Qualifacts + Credible Acquires InSync Healthcare Solutions

GETTYSBURG, Pa. (January 9, 2022) – Qualifacts + Credible, a leading provider of electronic health record platforms for behavioral health and human services organizations, today announced it has acquired InSync Healthcare Solutions.

InSync Healthcare Solutions is a leading provider of EHR and practice management software plus revenue cycle management services for behavioral, medical and rehabilitative professionals.

Qualifacts + Credible is adding InSync’s highly configurable, clean and intuitive platform to their portfolio of EHR solutions.

“The acquisition allows the combined organization to deliver innovation, technology, customer support, and complementary solutions to a broader behavioral health and human services market,” said Paul Ricci, chief executive officer of Qualifacts + Credible. ”It also better positions us for long-term growth by expanding our ability to serve small to medium-sized practices and agencies.”

Demand for behavioral health is on the rise, according to data from the Kaiser Family Foundation. As of January 2021, approximately four in 10 U.S. adults reported symptoms of anxiety or depression compared to one in 10 from January–June of 2019.

About 40% of behavioral providers work in smaller behavioral health organizations with fewer than 50 full time employees.

The company will continue to support all three platforms, with CareLogic and the Credible platforms remaining primarily focused on enterprise accounts.

InSync’s flexible and easy to use solutions for small to medium-sized practices and agencies will be enhanced by Qualifacts + Credible’s innovation and advanced technology capabilities.

“We’re excited to be part of an organization that is also focused on providing technology that empowers behavioral health providers to deliver the best care,” said Roland Therriault, executive vice president and general manager of InSync Healthcare Solutions.

Qualifacts + Credible currently has over 900 customers across 43 states making it one of the largest behavioral health EHR vendors in the country. The addition of InSync doubles the size of the organization’s customer count and it will serve over 10 million patients in all 50 states.

ABOUT QUALIFACTS + CREDIBLE    

Qualifacts + Credible is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience and two of the highest rated platforms, its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement.

ABOUT WARBURG PINCUS 
Qualifacts + Credible is a portfolio company of private equity firm Warburg Pincus LLC.

This leading global growth investor has more than $67 billion in private equity assets under management. The firm’s active portfolio of more than 215 companies is highly diversified by stage, sector, and geography. Warburg Pincus is an experienced partner to management teams seeking to build durable companies with sustainable value.

ABOUT INSYNC HEALTHCARE SOLUTIONS    
InSync Healthcare Solutions is a leading provider of EHR and practice management software plus revenue cycle management services for behavioral, medical and rehabilitative professionals. InSync leverages advanced technology, best-in-class partnerships and proven business processes to provide services and solutions that translate into better efficiency for healthcare organizations.

CMS Designates Connecticut Health Plan’s Episodes-Of-Care Payment Model As One Of TheFirst Commercial Plan Other Payer Advanced Alternative Payment Model

On October 7, 2021, the Centers for Medicare & Medicaid Services (CMS) approved a new payment model—the Episodes of Care program—between the State of Connecticut Health Plan for state employees and several provider organizations as an Other Payer Advanced Alternative Payment Model (A-APM). This Other Payer A-APM designation is one of the first earned by a commercial health plan, which starting in 2022 allows the Connecticut Health Plan network professionals to earn credit for participating in value-based care for the Medicare Quality Payment Program (QPP). The Connecticut Health Plan Episodes of Care program is for covered state employees and retirees, as well as members of the Connecticut Partnership Plan, which offers health care coverage to municipal employees.

The State of Connecticut’s commercial employee and retiree health plans, as well as the Connecticut Partnership Plan, launched the Episodes of Care program in October 2020. The Connecticut Health Plan covers state and certain municipal workers, retirees, and their dependents, totaling about 260,000 covered lives, and 210,000 are covered by the episode program. The remaining 50,000 are in a group Medicare Advantage plan in which the episode program does not apply.

The Episodes of Care program sets fixed episode prices covering evaluation through recovery for over 40 common health episodes that may be delivered by multiple provider organizations or professionals across multiple sites. The services included in the episodes account for up to 60% of the average health plan spending. The episodes include knee replacement, colonoscopy, cataract surgery, care related to pregnancy, and a comprehensive spine episode. The full list can be viewed online at https://www.careinnovationinstitute.com/episodes-summaries/ (accessed October 27, 2021).

The Connecticut State Health Plan episode-of care-model establishes a target episode price with each participating provider organization based upon the provider organization’s past performance. The episodes are retrospective, meaning that episode performance against the benchmark is calculated after the completion of the episode by aggregating the cost of all the claims associated with the baseline episode. Episodes are reconciled on a quarterly basis. The risk level of the participating provider organization groups varies based upon the financial ability of each to take on risk and their risk tolerance.

The Connecticut Office of the State Comptroller partnered with Signify Health during 2020 to create a new “Network of Distinction” program. The network includes hospitals, health systems, and physician groups. Each has low rates of complications and below-average episode prices. Since its inception last year,1,400 physicians have committed to the state’s quality and cost standards through their participation in the Network of Distinction. Additional provider organization groups are still eligible to join.

The hospitals, health systems, and physician groups selected into the Network of Distinction all have low rates of complications and below-average episode prices. Signify Health is supporting the Connecticut Episodes of Care program by identifying, contracting with, and supporting participating provider organizations with services, technology, and analytics, as well as securing fixed, episodes-of-care pricing with high-value network provider organizations participating in the Network of Distinction.

The QPP was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which restructured how Medicare pays clinical professionals. MACRA repealed the Medicare sustainable growth rate; established permanent statutory payment updates; and created incentive payments for participants in A-APMs. An A-APM must meet three criteria: require clinical professionals to use certified electronic health records (EHRs); tie payments to quality measures; and require eligible clinical professionals to bear nominal financial risk. Eligible Medicare professionals must participate in an A-APM or the merit-based incentive payment system (MIPS). Non-exempt eligible clinical professionals who fail to participate in an A-APM or MIPS are subject to lower Medicare reimbursements for the following year. Those who do participate are eligible for QPP bonus payments.

Signify Health is a health care platform that leverages advanced analytics, technology, and nationwide health care provider networks to create and power value-based payment programs. Its mission is to transform how care is paid for and delivered. Its solutions support value-based payment programs by aligning financial incentives around outcomes, providing tools to health plans and health care provider organizations designed to assess and manage risk and identify actionable opportunities for improved consumer outcomes, coordination, and cost-savings.

For more information, contact:

Massachusetts FQHC Centers Surpass One Million Telehealth Visits

The Massachusetts Federally Qualified Health Center (FQHC) Telehealth Consortium’s 35 community health center members have conducted more than one million telemedicine visits since the start of coronavirus disease 2019 (COVID-19) in March of 2020. This achievement comes at the same time the Consortium has passed the halfway mark of its Phase II $12 million fundraising goal – thanks to a major grant from the Gordon and Betty Moore Foundation – to attain sustainable telehealth capacity at health centers and address health disparities in the communities served by them.

Consortium data measuring telehealth use between May 2020 and May 2021 show that telemedicine visits have provided safe and convenient access to primary care for communities of color, which have been disproportionately impacted by COVID-19. Of the 767, 234 Massachusetts health center consumers who accessed primary care via telemedicine visits during that year-long period, more than 52% were white, nearly 21% were Black/African American, more than 6% identified as more than one race, more than 5% were Asian/Pacific Islander, and 1% were Native American. Of those identified by ethnicity, nearly 31% were Latinx/Hispanic.

According to the data, the same held true for behavioral health care services. Of the total number of consumers taking part in behavioral health telehealth visits during the same one-year period, nearly 56% were white, more than 23% were Black/African American, more than 5% were of more than one race, 4.65% were Asian/Pacific islander, and less than 1% were Native American. By ethnicity, 31% again identified as Latinx/Hispanic.

Phase II of the Consortium’s campaign is focused on ensuring that FQHCs have what they need to fully develop, deploy, sustain, and integrate telehealth modalities into primary and behavioral care, while also addressing the digital divide in their communities. This includes providing better access to broadband and remote monitoring equipment, increased digital literacy training, peer learning, outreach in communities that health centers serve, and online dissemination of best practices.

Phase II of the campaign launched in the fall of 2020 with $1,040,000 received from an anonymous donor to create skilled bandwidth at nine pilot sites required to integrate advanced, durable, and mature telehealth capabilities into member FQHCs. Another $3.1 million grant awarded by the U.S. Federal Communications Commission (FCC) in January as part of the FCC Connected Care Pilot Program is providing equipment and hot spots for consumer broadband access. The grant from the Gordon and Betty Moore Foundation ($878,000) is designed to increase the number of consumers with controlled hypertension, particularly for African American/Black consumers, and to test the additional value of telehealth navigators and clinical intervention over federal funding of remote monitoring.

The Consortium is a partnership of Community Care Cooperative (C3), the accountable care organization (ACO) that advances community-based care for MassHealth members, and the Massachusetts League of Community Health Centers, the state-based association of health centers.

Community Care Cooperative (C3) is a not-for-profit ACO that leverages the proven best practices of ACOs throughout the country and is the only ACO in Massachusetts founded and governed by Federally Qualified Health Centers (FQHC) and exclusively focused on advancing integrated and coordinated community-based care for MassHealth members. C3 works with its 18 member FQHCs to strengthen health centers across the state, and continued growth enables C3 to better serve MassHealth members across the Commonwealth. To view a list of C3 health centers, click here.

The Massachusetts League of Community Health Centers (the League) is a not-for-profit membership organization supporting and representing the Commonwealth’s 52 community health centers, which offer primary and preventive care to more than one million residents. The League serves as an information resource on community-based primary care to policymakers, opinion leaders, and the media. It provides a wide range of technical assistance to its health center members, including advocacy on health policy issues, support for workforce development, clinical care and technology initiatives, and guidance to state leaders and community-based organizations seeking to open health centers.

The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, consumer care improvements, and preservation of the special character of the Bay Area.

This was reported by The Massachusetts FQHC Telehealth Consortium on August 24, 2021.

Contact information: Abby Akoury, Chief of Staff, Community Care Cooperative, 75 Federal Street, 7th Floor, Boston, Massachusetts 02110; 857-302-4261; Email: aakoury@c3aco.org; Website: https://www.communitycarecooperative.org/

Contact information: The Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, Massachusetts 02108; 617-426-2225; Email: massleague@massleague.org; Website: https://massleague.org/

Contact information: The Gordon and Betty Moore Foundation, 1661 Page Mill Rd, Palo Alto, CA 94304; 650-213-3000; Email: communications@moore.org; Website: https://www.moore.org/

Babylon, A World Leading, Digital-First, Value-Based Care Company, Announces Plans To Become A Public Company Via $4.2 Billion Merger With Alkuri Global Acquisition Corp.

Babylon Holdings Limited (Babylon), a world leading, digital-first value-based care company, and Alkuri Global Acquisition Corp. (Alkuri Global), a special purpose acquisition company, announced that they have entered into a definitive merger agreement. Upon closing of the transaction, the combined company will operate as Babylon and plans to trade on Nasdaq under the new symbol “BBLN”. The transaction reflects an initial pro forma equity value of approximately $4.2 billion. The transaction is expected to close in the second half of 2021.

Babylon was founded in 2013, with the mission to put accessible and affordable quality healthcare in the hands of every person on Earth. Babylon is poised to re-engineer the $10 trillion global healthcare market to better align systemwide incentives and shift the focus from reactive sick care to preventative healthcare, resulting in better member health, improved member experience and reduced costs. Babylon helps consumers through two primary channels — Babylon 360, its digital-first value-based care service; and Babylon Cloud Services, a suite of digital self-care tools that enables consumers and primary care professionals to gain insights and information either through Babylon directly or through Babylon’s roster of top-tier partners. Combined, those services cover 24 million people across the United States, Canada, Europe, Africa and 13 countries in Asia. In 2020, the company had approximately 6 million consumer interactions. Moreover, Babylon has a 95% user retention rate and a 5-star rating from more than 90% of its users.

Supported by capital raised through the transaction, Babylon will continue to expand its services both with existing and new consumers. Babylon has achieved strong traction in the U.S. market and is focused on building on this momentum by rapidly scaling its operations.

The transaction is expected to deliver up to $575 million of gross proceeds to fund Babylon’s pro forma balance sheet, including the contribution of up to $345 million of cash held in Alkuri Global’s trust account assuming no redemptions. The combination is further supported by a $230 million private placement (the PIPE) – funded over 85% from new, external institutional investors including AMF Pensionsförsäkring, Sectoral Asset Management and Swedbank Robur with strategic investor Palantir – at $10.00 per share. There is additional participation from Ali Parsa, Alkuri Sponsor LLC and existing Babylon investors Kinnevik and VNV Global. In addition, Babylon previously acquired an option to purchase Higi, a consumer health engagement company, and intends to acquire the remaining Higi equity stake it does not already own. The major investors in Higi, including 7wire Ventures, Flare Capital Partners and William Wrigley, Jr., have agreed to accept shares in lieu of a portion of cash consideration if Babylon exercises its option. This agreement is expected to reduce Babylon’s cash needs by approximately $40 million.

Assuming no redemptions, taking existing cash and transaction fees into account, Babylon is expected to have approximately $540 million net cash on its balance sheet following the transaction, which will be used to pursue organic growth strategies as well as attractive and opportunistic acquisitions. The transaction reflects an initial pro forma equity value of approximately $4.2 billion and enterprise value of approximately $3.6 billion. Existing Babylon shareholders will roll 100% of their equity into the combined company and will own approximately 84% of the pro forma company at closing.

The transaction, which has been unanimously approved by the Boards of Directors of both Babylon and Alkuri Global, is expected to close in the second half of 2021, subject to approval by Alkuri Global’s stockholders and other customary closing conditions, including any applicable regulatory approvals. Following the closing of the proposed business combination, Babylon will retain its experienced management team. Dr. Parsa will continue to serve as Chief Executive Officer and Chairman of the Board. An Alkuri Global representative will join the Babylon Board of Directors.

Ardea Partners LP is serving as financial advisor, Citi is serving as financial and capital markets advisor, and Wilson Sonsini Goodrich & Rosati, P.C., Allen & Overy LLP and Walkers (Jersey) LLP are serving as legal counsel to Babylon. Jefferies is serving as exclusive financial advisor and Winston & Strawn LLP is serving as legal counsel to Alkuri Global. Jefferies, Citi, and Pareto Securities AB served as placement agents on the PIPE.

Babylon is a world leading, digital-first, value-based care company whose mission is to make high-quality healthcare accessible and affordable for everyone on Earth. Babylon is re-engineering healthcare, shifting the focus from sick care to preventative healthcare so that consumers experience better health, and reduced costs. This is achieved by leveraging a highly scalable, digital-first platform combined with high quality, virtual clinical operations to provide all-in-one, personalized healthcare. Babylon endeavors to keep consumers at the peak of health and get them back on their feet as quickly as possible, all from their devices, with the aim to promote longer and healthier lives. When sick, Babylon provides assistance to navigate the health system, connecting consumers digitally to the right primary care professional 24/7, at no additional cost. Founded in 2013, Babylon has since delivered millions of clinical consultations and AI interactions, with c.2m clinical consultations and c.3.9m AI interactions in 2020 alone. Babylon works with governments, health provider organizations and insurers across the globe, and support healthcare facilities from small local practices to large hospitals.

Babylon 360 is Babylon’s digital-first value-based care service. Babylon 360 combines cutting-edge AI-powered technology with human medical expertise to help members stay out of the hospital and remain in control of their health. Using a combination of Babylon’s primary care professionals’ expertise and data, Babylon 360 gives members actionable insights and information about their wellbeing, and – by helping members to understand their specific needs – helps them set personalized health goals. If there’s a problem, Babylon 360 gives 24/7 access to a dedicated Personal Care Team, so that consumers can receive the most appropriate care, medication and treatment. A recent survey among Babylon 360 members identified that more than 40% of consultations had resulted in consumers avoiding the emergency room or urgent care visits, generating significant cost savings.

Babylon Cloud Services provides a suite of digital self-care tools that enables consumers and primary care professionals to gain insights and information either through Babylon directly or through Babylon’s roster of top-tier partners. The tools include Babylon’s AI symptom checker, which provides a 24/7 source of health information to consumers when they need it, and Babylon’s Healthcheck, which offers a comprehensive, digital-first health assessment that identifies at-risk conditions and actionable next steps members can take which aim to improve overall health and decrease future risk of disease.

Alkuri Global Acquisition Corp. is a blank check company formed for the purpose of effecting a merger, stock exchange, asset acquisition, stock purchase, reorganization, or similar business combination with one or more businesses or entities. Alkuri Global intends to favor next-generation technology businesses led by visionary founders and teams leveraging data and artificial intelligence in the areas of Consumer Internet and Marketplaces, Healthtech, Fintech and Mobility.

This was reported by Babylon Health on June 3, 2021.

Contact information: Ali Parsa, Ph.D., Chief Executive Officer, Babylon Health, 60 Sloane Avenue, London United Kingdom; SW3 3DD; +44 (0)20 7100 0762; Email: support@babylonhealth.com; Website: https://www.babylonhealth.com/

Contact information: Alkuri Global Acquisition Corp., 4235 Hillsboro Pike, Suite 300 Nashville, TN 37215; 615-632-0303; Website: https://www.alkuri.com/


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Eleanor Health Announces $20 Million Series B Financing To Address The Growing Need For Value-Based Addiction & Mental Health Treatment

Eleanor Health, the first outpatient addiction and mental health provider organization delivering convenient and comprehensive care through a population and value-based payment structure, announced it has closed an oversubscribed $20 million Series B financing round. The company received significant participation from all existing investors including Town Hall Ventures, Echo Health Ventures, and Mosaic Health Solutions, as well as new participation from Warburg Pincus, a global private equity firm which has invested more than $90 billion in over 930 companies.

Eleanor Health will use the capital to meet increased need from communities and demand from payers for population, value-based, whole-person care for individuals with drug addiction and mental health needs. By 2022, Eleanor Health anticipates managing more than 50,000 members under its innovative population-based partnership models.

Within the past two years, the company has shown the following results throughout its physical and virtual footprint:

  • 84% reduction in emergency department and inpatient stays.
  • 70% report improvement in depression and anxiety.
  • 84% improvement in drug addiction.
  • 76% report improvement in social drivers of health.

To date, Eleanor Health operates 18 clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers. The company plans to scale the business by going deeper in existing markets by executing additional payer contracts to manage new populations and further developing its proprietary analytics and technology platform that will support identification, engagement, and treatment.

Eleanor Health was created in the Oxeon Venture Studio, together with Town Hall Ventures and Mosaic. It remains dedicated to:

  • Providing treatment where most convenient for community members, including in-person care in clinics, community-based care in homes, and a 100% virtual model available from the safety and convenience of home;
  • Delivering comprehensive services including medications for drug addiction, psychiatric evaluation, treatment of co-occurring psychiatric conditions, individual and group therapy, nurse care management, support to address social determinants of health, and peer recovery coaching;
  • Operating on a payment structure that includes accountability to positive health outcomes achieved, including reducing total health care costs, providing unmatched access, and achieving high consumer satisfaction;
  • Employing diverse teams of medical practitioners, nurses, addiction professionals and peer recovery coaches with personal lived experience, to engage and support individuals in achieving their recovery goals;
  • And coordinating care across the health care and social services continuum to improve the consumer journey and increase long-term recovery rates and overall health outcomes for individuals.

This was reported by Eleanor Health on May 17, 2021.

Contact information: Alex Piersiak, Eleanor Health, 155 Federal Street, Suite 700, Boston, MA 02110; 617-909-5022; Email: alexandra.piersiak@eleanorhealth.com; Website: https://www.eleanorhealth.com/

Caron Treatment Centers & Independence Blue Cross Report Value-Based Contract Linked To Lower 90-Day Readmission Rate

Independence Blue Cross (IBC) reported that its value-based arrangement with addiction treatment provider Caron Treatment Centers resulted in a 5.6% 90-day readmission rate during a 2019 pilot. Under the arrangement, IBC paid Caron one single upfront fee for IBC members receiving treatment for addiction disorder, and Caron was at risk for any readmissions that occurred within the first 90 days after discharge.

IBC and Caron reported the pilot outcomes in a presentation at the 2021 Rx Drug Abuse & Heroin Summit. In the presentation, IBC reported that the readmission rates for six other addiction treatment providers in its network ranged from 11.6% to 25.7%. In total, 645 IBC members were treated for addiction during 2019; 71 received treatment at Caron.

Caron entered the value-based arrangement with IBC in 2017. The fee IBC pays Caron was not disclosed. In the presentation, Richard Snyder, M.D., IBC’s chief medical officer said the single payment is more than the rate IBC paid to the other addiction treatment provider organizations. However, he said the total cost of treatment has been about the same because Caron’s readmission rate was lower and IBC was not at-risk for the readmission cost.

Caron Treatment Centers is an internationally recognized non-profit organization that provides addiction and behavioral health care treatment, research, prevention, and addiction medicine education. The organization provides a continuum of care for teens, young adults, women, men, and older adults. Caron’s signature programming provides concierge treatment for executives, health care professionals, older adults and first responders. Caron’s program includes multidisciplinary treatment protocols with a median inpatient stay of 25 days, combined with a long-term disease management plan. Pennsylvania-based Caron provides services in Palm Beach County, Florida; Philadelphia; Washington, D.C.; Atlanta; and New York City. The organization is in-network with Capital BlueCross, Aetna, Highmark, and the Blue Card program, Independence Blue Cross, AmeriHealth Administrators, Independence Administrators, UPMC, Blue Cross Blue Shield, Employer Groups of Penn Medicine, and Tower Health.

IBC is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. Independence ended 2020 serving 8.1 million members nationwide.

IBC and Caron reported the outcomes at the Rx Drug Abuse & Heroin Summit on April 7, 2021.

Contact information: Karen Pasternack, Senior Director of Media Relations, Caron Treatment Centers, 243 N. Galen Hall Road, P.O. Box 150, Wernersville, Pennsylvania 19565; 610-413-6938; Email: kpasternack@caron.org; Website: https://www.caron.org/

Contact Information: Diana Quattrone, Corporate Communications Manager, Independence Blue Cross, 1901 Market Street, Philadelphia, PA 19103; 215-241-3113; Email: diana.quattrone@ibx.com; Website: www.ibx.com

A Game Plan for Building a Sustainable Certified Community Behavioral Health Clinic (CCBHC)

The goal of the Certified Community Behavioral Health Clinics (CCBHC) is to improve patient care across the healthcare spectrum, serving highly complex patients while avoiding the use of high-cost, low-return care models though community-based alternatives that improve care management. Based on the success of the first wave of CCHBC’s, Congress has acted five times to extend the demonstration project and has allocated $450 million (to date) for CCBHC expansion grants. The number of CCBHC’s have expanded from 66 in 2015, to 166 in 2020.  The Substance Abuse and Mental Health Services Administration (SAMHSA) has embraced the CCBHC concept of integrated care and behavioral health providers, who have long supported integrated care, are now looking to the CCBHC model as an economically viable way to support this model of care.

Indeed, CCBHC’s have an excellent opportunity to be leaders in the new integrated healthcare system if they can display the following specific values:

  1. Accessibility: All needed services – mental health, substance abuse treatment, and physical health care – are provided in-house or quickly, in proximity, within the community.
  2. Efficiency: Multiple services can be provided daily, with one patient visit instead of multiple visits.
  3. Connection: Electronic Health Records (EHR) are used across service lines to produce and track clinical and quality metrics.
  4. Accountability: A commitment to producing the array of quality metrics required for quarterly reporting, in nearly real time.
  5. Adaptability: A commitment to using bundled payment arrangements that help clinics adopt and utilize alternative payment models instead of fee-for-service.

To meet these core values, provider organizations, in many cases, have had to update their organization’s service lines, hire new staff, and implement or update Electronic Health Record systems (EHRs). These changes represent substantial economic and human resource expenses. While enhanced reimbursement and up-front grant dollars have helped to offset the expense, it still begs the question: “How does an organization sustain the model beyond the grant period?” (https://vbcforbh.com/are-you-really-ready-for-value-based-payment/)

Thinking Beyond Grant Funding

The recipients of the 2020 CCBHC Expansion Grant the funding stream are only guaranteed funding for two years. A few considerations are important. The first is that funding may not be renewed. Considering potential fiscal deficits expected from the COVID epidemic, there is a distinct possibility that additional funding will not be there. A second possibility is that state funding may supplant federal funding. As states grapple with the aftermath of a pandemic, fewer state dollars will be available.  Already, Nevada has made a 6% cut to Medicaid dollars (https://vbcforbh.com/nevada-moves-forward-with-6-medicaid-fee-for-service-rate-cut/).

SAMSHA was abundantly clear that grant participants should not expect more federal support. The newest round of grantees were given the task to: “Develop and implement plans for sustainability to ensure delivery of services once federal funding ends. Recipients should not anticipate the continued renewal of federal funding to support this effort. Federal funding is subject to funding availability and is also subject to a competitive grant award process. Recipients must develop and implement sustainability plans to ensure continued service once the grant ends. Recipients will be asked to report on sustainability plans” (https://www.samhsa.gov/sites/default/files/grants/pdf/fy-2020-ccbhc-foa.pdf).

The long-term sustainability of CCBHC programming requires a strategic response.

Community Behavioral Health Clinic (CCBHC) Sustainability and Value-Based Reimbursement

The CCBHC’s with an eye toward a future will be looking for alternative revenue streams immediately. The good news is that the CCBHC infrastructure of data driven health care focused on improved outcomes and diminished costs is an ideal match for payers who are looking for lower cost interventions and improved population health, and are using Value Based Reimbursement (VBR) to meet these goals.

The organizational readiness for CCBHC implementation has laid the groundwork for Value Based Programming.  The development of Evidenced Based Practices, addition of service lines, hiring new staff, affiliations with emergency care, adoption enhanced payment processes, and implementing and updating you Electronic Health Records (EHR) to capture clinical and quality data has positioned CCBHC to think about working with both private and public payers.

A Growing Value Based Culture

The OPEN MINDS 2019 State-By-State Update found that 28 of the 40 states with Medicaid managed care require health plans to implement alternative payment arrangements (APMs) with provider organizations. This is up from 22 states out of 39 states in 2017. And Value-Based processes are at the center of the trend. Organizational readiness for VBR follows a defined path:

(See OPEN MINDS Are You Really Ready for Value-Based Payment?)

The CCBHC is already this path, developing a VBR infrastructure. The next step is to define the unique value proposition of the CCBHC.

Defining the Unique Value Proposition to New Payors

A successful sustainability plan keeps the following goals in mind:

  • Have the Data: Understand internal unit costs and key performance indicators (KPI). Fortunately, the data needed to do this can be found in your CCBHC data. Use this to data to develop a picture of what the CCBHC does well, and where there are opportunities for improvement. Knowing strengths and possible risks will be important guides in rate negotiations.
  • Know the Customer: Research the payers in the market. For the health plans and accountable care organizations, know their structure and customers, their current service delivery network, executive teams, and their enrollment in your service areas. A CCBHC plan has flexibility to meet the changing needs of the marketplace. Alignment with those needs will make a CCBHC more attractive to payers that need services.  (See What Are Health Plans Actually Doing? and Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System).
  • Prepare for the End-Game. Think about future meetings with health plan executives to discuss current contracts and proposed services as the CCBHC plan is developed. Be prepared with a proposal and assess readiness for newer payment models (Use the Value-Based Reimbursement Readiness Assessment).

Build Relationships Now

Avoid scrambling at the last moment for new funding streams. Remember, payers know that mental health and substance use disorders are the leading causes of disease burden in America.  This is further exacerbated by co-morbidities faced by people with mental health and substance use disorders who also suffer from cardiovascular disease, and diabetes, and other chronic diseases. The CCBHC is addressing this issue head on and that needs to be highlighted. To do this you can start by doing the following:

  • Build relationships with payers immediately: Reach as high into the payer organization as possible to develop those relationships. Then attempt to establish formal touchpoints. A scorecard with quarterly data will provide updates on key points that may be of value to the health plan. These interactions need to be succinct and to the point.
  • Develop a Pitch Deck: Prepare a brief (one or two slide) value story that describes how the CCBHC’s programs are differentiated in terms of quality and costs, and how they contribute to health care cost savings for the payer.
  • Leverage Informal Meetings: Attend conferences and industry meetings with target payers. These less formal venues allow for additional touchpoints to reiterate the value the CCBHC brings to the table, and the differentiating strengths.

Finally, connecting with health plans comes down to persistence.  Provider organizations need to find the right contact in network management, or whoever is leading their local plan and continue to reach out. In the end, relationship-building is still based on quality communication. The CCBHC model is the perfect framework to build relationships with payer organizations.

COVID-19 and Value-Based Reimbursement: What Do We Know? Where Will it Go?

The impacts of COVID-19 on health care continue to unfold, and one area of uncertainty is the impact COVID will have on Value Based Reimbursements (VBR). Regardless of this uncertainty it appears that VBR is still trending upwards in behavioral health care.  Surveys conducted by OPEN MINDS demonstrate more use of episodic payments, case rates, and bundled rates. In one health plan survey, the number of health plans using bundled payments or case rates rose from 39% to 59% from 2017 to 2019 (see Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System and What Are The Health Plans Doing About VBR?). And, a more recent survey of specialty provider organizations found that 24% of those organizations have some bundled rate contracts (see 2020 OPEN MINDS Performance Management Executive Survey: Where Are We On The Road To Value). A similar trend is noted in the public payer market, where a recent state-by-state analysis found that 28 of the 40 states with Medicaid managed care require health plans to implement alternative payment arrangements (APMs) with provider organizations. This is up from 22 states out of 39 states in 2017

With the continued growth of VBR, many questions about how the pandemic will change VBR processes remain. Some current trends shed light on this question. These trends also give providers clues about areas of focus moving forward in this ‘next normal’.

Shift to Telehealth

One of the astonishing developments of the pandemic is the phenomenal growth of telehealth utilization in behavioral health care. Telehealth has become ubiquitous during the pandemic. Some interesting results of a recent survey by Qualifacts and the National Council for Behavioral Health include:

  • Pre-pandemic, telehealth utilization in behavioral health care was relatively low, only 2% of organizations were providing 80% or more of their care virtually
  • Policy changes during the COVID-19 pandemic have reduced barriers to telehealth. Now, 60% of behavioral health organizations are providing 80% or more virtual care.
  • Behavioral health care executives expect the higher utilization of virtual services to continue, with a majority believing 40 % to 60% of their overall services will be provide in virtual platforms.

In the public sector, there have been sweeping changes in regulation and reimbursement for telehealth services. While the permanence of the changes in the public payer space has not been determined, it’s evident a system-wide reevaluation is occurring.  Some states have enacted new legislation already. For instance, On July 6, 2020, the Colorado legislature passed Senate Bill 212 to expand access to Medicaid telehealth services. The bill expands Medicaid coverage for telehealth services to include reimbursement at parity with in-person services at rural health clinics, federally qualified health centers (FQHC’s), and the Indian Health Service facilities.

Furthermore, the shift to telehealth is also be reinforced by the recent recognition by the National Committee for Quality Assurance (NCQA) revision of HEDIS Quality Measures associated with Telehealth utilization during the pandemic. https://bhmpc.com/2016/10/hedis-success-value-based-care/

New NCQA HEDIS Telehealth Rules

NCQA  adjusted 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures—in response to the surge in telehealth during the pandemic (see NCQA HEDIS Quality Measures Adjusted For Increased Telehealth Use In Pandemic Crisis). The adjustments, published July 1, will go into effect in 2020 and include eight measures related to behavioral health—medication adherence, follow-up care after hospitalization or emergency department visits, and monitoring of co-occurring medical conditions in consumers with serious mental illness. For each measure, the updated guidance specifies how telehealth visits can be used and what will be included and excluded in the measure’s denominator and numerator. Most importantly, NCQA removed restrictions on video visits and now recognizes a video visit as the same as an in-person visit. Eight of the adjustments affect behavioral health measures (NCQA.org/COVID):

  1. Antidepressant Medication Management
  2. Follow-up Care for Children Prescribed ADHD Medication
  3. Follow-up After Hospitalization for Mental Illness
  4. Follow-up After Emergency Department Visit for Mental Illness
  5. Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
  6. Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
  7. Diabetes Monitoring for People with Diabetes and Schizophrenia
  8. Adherence to Antipsychotic Medications for Individuals with Schizophrenia

The implication of the of the updated HEDIS measures is that telehealth coverage will carry forward to the post-crisis future. As noted by the NCQA, they cannot drive quality improvement “if their measures don’t take into account what has quickly become the fastest-growing modality for providing health care services.” For behavioral health providers who see telehealth as significant portion of outpatient services this is good news. It will also allow for more flexibility in designing programming to address VBR processes, especially when access to in person care is a major obstacle. https://www.ncqa.org/covid/

Payers are aware of the increase in utilization of telehealth and will build VBR programs around the assumption that provider are utilizing telehealth as part of their service array. Providers with fully integrated telehealth programming will be at a distinct advantage when it comes to VBR readiness in the post crisis era.

The use of telehealth is just one tool in a provider’s service array. Some COVID-19 other trends provide insight into post pandemic behavioral health utilization needs and potential cost drivers that may stimulate VBR development.

Systemic Impact of COVID-19

One interesting trend is the current underutilization of behavioral health services.  Many behavioral health providers have experienced significant decreases in utilization and revenue streams due to COVID-19, in large part due to increased unemployment from COVID-19 and the transition time of shifting benefits from private to public payer sources.

Juxtaposed against underutilization is the increase level of mental health conditions associated with the pandemic. It is expected that there will increase in levels of trauma, depression, and anxiety occurring as a result of the pandemic. The April 2020 Johns Hopkins COVID-19 Civic Life and Public Health Survey Wave 1 demonstrated a 10% increase in adults reporting serious psychological distress over 2019 reports. These results showed an exacerbation for adults with household income of less than $35,000 per year, 19% of whom reported serious psychological distress. There is also expected to be an increase in suicide rates. Unemployment is highly correlated with deaths by suicide, which has led experts to speculate that suicides will increase in 2020/2021. One model, based upon previous suicide and unemployment data, projects 3,235 to 8,164 additional deaths by suicide in the United States in 2020/20212

For payers and providers these trends will, at some point, create an increased demand for behavioral health services. Behavioral health providers with services that align to these needs, like expertise in areas of trauma informed care and crisis intervention programming, will be positioned to better serve these population health needs and meet the needs of payers who are looking for better outcomes for their consumers.

A second area of concern for all providers is the increase in opioid utilization. Due to increased opioid usage during COVID, mortality rates are expected to climb due opioid-related deaths. The American Medical Association (AMA) recently released a statement of concern about reports of increased levels of addiction and opioid-related mortality.

Value-based programs around addiction treatment have been on the rise since before COVID, both Cigna and Anthem have developed VBR programs that look at claims data in their private and public plan, tied that data consumer satisfaction surveys and outcomes. (See OPEN MINDS Addiction by the Numbers.) With the rise in opioid utilization it is reasonable to expect continued development of this treatment programming.

A Final Thought on Integrations

What is also interesting about VBR moving forward is the focus on screening, prevention, and integration of physical health care and behavioral health. Many states and national measures have incentivized screening for depression or substance abuse in primary care settings. And many plans are incentivizing referrals to co-located services and warm hand-offs where co-located services are not available. For forward-thinking behavioral health providers, the need for strong relationships with physical health care providers will present another opportunity for expanding their footprint and enhancing their revenue cycle through VBR arrangements. (See How VBR Prioritizes Primary Care as the Center of Integration.)

 

Learn more about Value Based Reimbursement with these resources from the VBCforBH.com Library.

  1. There Is No “Plan B” Alternative to Value Creating A Value-Focused Competitive Strategy in A Changing Market
  2. How to Develop Alternative Payment Models: A Guide to Building Effective Bundled Payment Models
  3. Care Delivery in A Value-Based Era – Evidence-Based, Practice-Based, Standardized & Measurement-Based
  4. Developing Case Rates? Better Find Your ‘Single Source of Truth’
  5. Adjust Your Strategic Sails!
  6. When the Competition Succeeds at Pay-For-Performance, What Will You Do?
  7. Options for Alternative Payment Models for Behavioral Health
  8. Using Your Performance Metrics to Build A Value Proposition for Health Plans

Medicare ACOs Generated Savings Of 1% To 2%

Medicare accountable care organizations (ACOs) have generated 1% to 2% reductions in Medicare program spending, according to a review of ACO evaluations between 2012 and 2016. The savings estimates were consistent for ACOs participating in the Medicare Shared Savings Program (MSSP) and for those participating in the Next Generation (NextGen) ACO model. The Medicare ACO savings stem from small reductions in hospital inpatient, hospital outpatient, and post-acute care use compared to what would have been spent if the ACO program did not exist.

The Medicare savings estimate is before shared savings payments to those ACOs that earned savings. For . . .

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