Healthcare reform: Implications for organizational systems

By Todd Molfenter, NIATx Deputy Director

One of the goals of the Patient Protection and Affordable Care Act (ACA) is to lower the cost and improve the quality of care for everyone. Behavioral healthcare providers may be uncertain about the future of the legislation and what impact it will have. But the national trend toward fee-for-service and managed care—which also aims to lower the costs and improve quality of care—is requiring behavioral healthcare leaders to develop the same competencies they’ll need to be fully prepared for the changes anticipated with healthcare reform. 

These competencies include understanding and implementing health information technology (HIT), especially electronic health records (EHR) to improve quality, contain costs, and give patients greater control of their personal health.

Integration with primary care, another component of the ACA, is already happening, as behavioral health works to operate in conjunction with the broader health system.  In the HealthReform Readiness Index survey administered by NIATx, the percentage of behavioral health organizations that offer primary care increased from 6% to 15% from 2010 to 2012.

The movement toward managed care and fee-for-service reimbursement has been accompanied by changes in state funding. Behavioral healthcare providers are learning to expand their payer mix and their business skills, developing new systems for billing, managing accounts receivables, and reducing claim denials. Providers will need to have these systems firmly in place to accommodate both the Medicaid expansion anticipated with ACA and the Health Insurance Exchanges that will emerge—the new competitive markets that will allow consumers to purchase affordable private insurance plans.

·      Enrollment: Changes in state funding are requiring providers to help their patients determine their eligibility for public or private insurance coverage.  Efficient enrollment systems will also be essential with Medicaid expansion and HIEs.   

·      Workforce development: Today’s changes in funding and reimbursement are also driving the need for a workforce with the credentials and clinical competence that payers require.

·      Using outcomes to influence clinical decision-making: State governments and managed care increasingly require documentation that demonstrates quality indicators are being tracked and  a plan to continuously improve performance.

Whether or not the ACA is fully implemented as designed, behavioral health care providers who are working on these areas are setting themselves up for success in a funding environment that’s changing rapidly.

If you haven’t yet embarked on making the transition to this new environment, or if you’re not sure where to begin, take a look the HealthReform Readiness Index (HRRI) that NIATx developed. It’s a quick (under 15 minutes) survey that will let you know immediately where you are on the readiness spectrum. You might find that you’re in the early stages in one area, but well on your way in another. The HRRI is just one of many tools that you can use to help plan how to adapt your organization’s systems to the transformation of the behavioral healthcare field.