Western N.Y. BlueCross Introduces Value-Based Payment Model for Behavioral Health

March 2, 2020
Announces region’s first behavioral health value-based payment agreement with Value Network, a behavioral health collaborative with more than 100 providers

State governments and health plans are starting to develop value-based payment programs for behavioral health services. In one example, Blue Cross Blue Shield of Western New York recently announced the region’s first behavioral health value-based payment agreement with Value Network,  a behavioral health care collaborative with more than 100 area providers.

 A value-based payment model focuses on quality of care, rewards healthcare providers for complete care management of their patients’ health and allows them to manage patients with more flexibility. 

 Buffalo-based BlueCross BlueShield will reward behavioral health providers for delivering quality mental health and substance use disorder treatment to its members. This follows the health plan’s roll out of a value-based approach for compensating primary care doctors in January 2017.

 “This is another step we’re taking to build a behavioral healthcare model that’s designed to effectively treat the whole person,” said Thomas Schenk, senior vice president and chief medical officer, BlueCross BlueShield of Western New York, in a statement. “BlueCross BlueShield of Western New York is proud to partner with the region’s leading behavioral healthcare providers to introduce the first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses.”

 Value Network is comprised of 23 providers licensed through the New York State Office of Mental Health or New York State Office of Addiction Services and Supports, as well as designated Home and Community Based Service Providers. It has 65 other partners, including hospitals, primary care partners, prevention agencies, care-coordination entities, and other agencies that serve those who need assistance.

 BlueCross BlueShield also identified behavioral health as one of the key focus areas of the health focused grant program, Blue Fund. Launched in 2018, Blue Fund awarded grants to support Buffalo MATTERS, a program that immediately connects patients in emergency departments for opioid use with follow up appointments; Save the Michaels’ Court Treatment Program, a program that places and transports patients to treatment and provides recovery coaches to families of adjudicated users; Horizon’s new Family Training Center at Horizon Village, a program that provides expanded staff training and comprehensive after-care services for patients; Compeer Maryvale Leaders, a program that supports mental wellness mentoring in the Maryvale School District; and Directions: A Mobile Behavioral Health Project, a mobile van that provides behavioral health support to rural and underserved communities. 

 Additionally, to help facilitate greater coordination between behavioral health treatment providers, primary care providers, and other needed treatment providers, BlueCross BlueShield expanded its team of qualified behavioral health professionals and transitioned all health management services internally in 2017. As a result, engagement with members seeking behavioral health treatment has increased nearly 120 percent.

 As noted by a 2017 Center for Health Care Strategies Inc. white paper, Medicaid managed care organizations also are building upon models developed for physical health services and incorporating value-based payment arrangements into behavioral health programs. The paper found that key challenges in implementing value-based payment models in behavioral health settings relate to quality measurement, provider capacity, oversight considerations, and privacy and data-sharing constraints.