case mangagement/crisis intervention/Healthcare

Why Mental Health Crisis Services Should Be Considered a Value-Based Payment

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Just your average Saturday for me as a tweet makes me want to write a blog post…. about value-based payments. So for those of you who are not familiar with the concept, right now most insurance companies give out payments in a Fee-for-Service structure. You provide a service… get paid a flat rate from an insurance company for providing the service. Lots of insurance companies have started to reimburse in a value based structure.

The New England Journal of Medicine Catalyst magazine offers this definition…

Value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.

So rewind to earlier this evening I came across this tweet …

This was from the recent American Association of Suicidology conference in Washington D.C. The notion of having some talk to at 3am made me think about the service Crisis Text Line (CTL). For those of you who don’t know CTL is a non-profit that offers free suicide prevention counseling via text (currently available in United State and Canada, but growing). One of the things CTL provides is some basic data on their website.

I recalled that time of day is one of the stats they post on CrisisTrends.org..

If you notice the overall trend is a larger percent of text volume happens during non-traditional hours. If you are insurance company an outpatient clinic has you covered from 9am – 6pm. How ever the emergency room has you covered the rest of the time. As you look at the graph it is important to note the text volume from 6pm to 2am. Doing some quick math only about 42 percent of the text volume being during business hours; with majority happening off hours.

I am not arguing that we need to keep funding outpatient providers so that they stay open until 12am. What I am attempting to make argument for is public/private partnerships to assist people in times of need. On the national level, both CTL and The National Suicide Prevention Lifeline provide support. I am not certain if this mimics landline phone crisis services as well but these services are providing a value the public. On the state and local level there are crisis centers that provide support. Even more locally there is increased funding for mobile crisis teams.

This is hardly a scientific study but I challenge insurance companies to look at their claims data for mental health crisis. Think about how you can drive value other than emergency room and inpatient services. As someone who used to work in an ER setting, I can tell you the evening is busy. I can also tell you that midnight is busy too. Text and phone crisis services are typically done by low-funded services. The value proposition here is that CTL and other services are there. That local crisis centers need funding and you (insurance company and health system) have to meet your members needs. They are potentially benefiting your members and you might not even know it. As communities think about the switch from fee for service to value-based payments; payers, hospitals, mental health clinics, and communities need think about how off hours mental health deserve attention. That innovative partnerships are possible to meet these growing needs.

More Info:

Crisis Text Line is looking to partner with local emergency services and non-profits in need.

I would also encourage you to find your local crisis center in the National Suicide Prevention Lifeline Network.

Also stakeholders should review The Action Alliance for Suicide Prevention document on reforming crisis services called “Crisis Now”.

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