The shift to value-based care has provided new opportunities to improve behavioral health outcomes. As of January 1, 2017, Medicare provides payment to support Behavioral Health Integration (BHI) services. This reimbursement allows providers in Accountable Care Organizations (ACOs) to take a significant step away from the traditional treatment options that sometimes acted as silos that separated behavioral health from physical health and move toward a holistic team-based treatment approach – one that improves outcomes, reduces unnecessary visits, and lowers costs.
The lifespan for Americans with mental and behavioral health conditions is shorter than the general population.  Estimated spending on behavioral health conditions vary, however studies consistently demonstrate that these conditions drive utilization costs more than any other medical condition including cardiovascular disease - the nation’s leading cause of death.  Despite the fact that nearly 60% of those with a behavioral health disorder didn’t receive treatment in the previous year, mental health is the single most expensive medical condition in the U.S. 
How can moving to a value-based system address behavioral health in an innovative way? In short, it’s all about population health. We often hear, ‘there is no health without behavioral health’, and by successfully treating the whole patient, practices can generate population health revenue from services such as BHI through more practical and cost-effective approaches.
Depression, for example, affects 16.2 million Americans.  Rates of depression are higher in older individuals and, despite its prevalence, the illness often goes untreated. Data extrapolated from Caravan Health ACOs in 2017 demonstrate that 33% of attributed patients exhibited evidence of depression. However, only 17% of those patients had claims from behavioral health specialists. Patients with at least one psychiatric visit and patients experiencing mental health conditions are among the most predictive attributes when describing high ED utilizers. Data consistently indicate that treating the whole patient – including addressing their individual social determinants is essential to improving patient outcomes.
In Caravan Health’s ACO model, we put a strategic emphasis on preventive treatment solutions including Annual Wellness Visits (AWV) and BHI. The AWV provides a foundation to the Behavioral Health continuum by allowing providers to easily administer behavioral health screenings, provide treatment plans, recommend psychiatric care, and provide ongoing follow up, all reimbursed by Medicare. By holistically attending to the patient rather than the symptom, social determinants and both physical and behavioral health conditions can be effectively integrated into a comprehensive treatment plan that benefits the patient and provider.
The social determinants of health and behavioral health care are intertwined. The CDC defines the social determinants of health as the conditions in the places where people live, learn, work, and play and how they affect a wide range of health risks and outcomes. Clinicians must consider the social determinants when assessing the behavioral health of their patients.
Diagnosing and treating behavioral health can be subjective and social factors such as food insecurity, transportation limitations, and literacy can often hamper compliance with medical instruction. When a patient is unable to follow through with a treatment plan, the likelihood of additional intervention increases along with the associated costs.
Value-based payment models, including ACOs, could hold the key to transforming how we provide behavioral health care to those who need it most. The commitment from Medicare to reimburse for behavioral health services is a positive step. By implementing a population health-based approach, Caravan Health ACOs have generated better clinical outcomes as well as impressive savings. Addressing behavioral health as part of a whole person-centered model of care is a promising path for the patient, provider, and payer.