There is no question the healthcare landscape is changing rapidly and will continue to do so as insurance-based reimbursement becomes the primary source of funding for behavioral health treatment providers, whether it is Medicaid or private insurance from the healthcare exchanges. The essentials for change that providers will need to have include an updated electronic health record system with the ability to bill payers electronically. Real time performance data and the ability of providers to respond effectively to performance-based contracting will have enormous implications for the current data systems at both the state and provider levels. Evidence-based practices in service delivery will be demanded as well.
Providers will be operating in an aggressive managed care environment and staff will need to be trained to manage insurance-based reimbursement and managed care entities. National accreditation has now become an expectation.
In the medicalization and integration of addiction treatment that is anticipated, providers will need to have contractual linkages with primary care clinics/medical homes and with federally qualified healthcare facilities. A chronic care model of service delivery will be the norm giving rise to the need for recovery oriented systems of care in which case managers and others assist patients in accessing needed and often repeated care within coordinated service continuum’s with co-occurring capacity. Step down care and extended aftercare/continuing care services will become essential within the service continuum. Both public and private addiction treatment providers will be affected by these expectations.
Providers will need to demonstrate outcomes and also will need to have in place an internal quality monitoring program that is based upon measurable quality indicators. Such a program must extend well beyond the patient’s discharge from primary services. Accountability will truly take on new meaning and proportion as the affordable care era evolves.
With all of this change, organizations may find they need the help of a group like the Addictions Consulting Group, to address the clinical operations of their business. Staff will continue to need training in biopsychosocial evaluation of patients, individualized treatment planning and record documentation that meets national standards.
ACG has long-term experienced clinical and operations individuals who are capable of assisting you with any of the major drivers of change in your operation. Our folks have been in the trenches of behavioral health programs and know how to design programs and services that will successfully compete in this new environment.