Q&A: A Nonprofit CEO on the Future of Behavioral Health Care
Crain’s Health Pulse July 29, 2019
As president and CEO of the Lower Eastside Service Center, Valerie Walters is accustomed to relying on direct government funds to support the substance-use treatment, supportive housing and other services her organization provides to vulnerable clients. The state is now working to equip behavioral health providers to participate in the modern value-based landscape. A $60 million state program to create 19 behavioral health care collaboratives—regional networks of providers that work together to demonstrate their value to payers—is now in the middle of its third and final year. Walters, who leads the Lower Eastside Service Center Behavioral Health Care Collaborative, spoke to Crain's about how her network is preparing for the future.
What makes it difficult for behavioral health providers to adapt to value-based payments?
In the social services arena, we're good at telling stories but not good at measuring outcomes. It's more qualitative than quantitative, and managed-care companies want numbers. The $3.1 million we got from the BHCC program gave us the opportunity to put systems in place where LESC and other agencies could come together and work for the best outcomes of the clients.
What kind of capacity-building have you done to prepare for value-based payments?
All the BHCCs that got money needed IT infrastructure. We put a system in place to allow us to coordinate and track client care and to make sure we have the cost information we need to sit at the table with managed-care companies. We also hired an accountant to go into each individual agency to look at their data and the cost of doing business.
The state's goal for the program is for behavioral health care collaboratives to participate in value-based deals with some level of risk-sharing. Have those opportunities been available?
That's been the biggest challenge so far. We put in our application to become an independent practice association because, as a BHCC, we can only do small projects, but as an IPA, we can talk about contracting. But we need the managed-care companies to be willing to work with us. All the BHCCs are asking the state to encourage managed-care companies to sit at the table with us, but they can't force them.
What are you doing to better position the Lower Eastside Service Center BHCC to negotiate with payers?
We are working on becoming an affiliate of an established IPA/ACO that specializes in primary care. Behavioral health on its own is difficult to measure. Primary care is a key component. We are also working on a pilot we can bring to a managed-care company. Our BHCC serves about 1,300 folks, who fall into the category of the most expensive people in the system because they use the emergency room so much. We want to show how we can work with this unique group of individuals to get them the services they need and demonstrate that after we start working with them, the cost goes down.
What should the state do to support BHCCs moving forward?
I think they should expand this readiness period. Three years is not enough to get all the systems in place. Once we're an IPA, we will use a capital call to raise money from members for back-office support. But if the state could put up more money for IT infrastructure, that's the most expensive part of it. Right now, though, we're at a crossroads where until the managed-care companies are ready to do business with behavioral health, it's a moot point. —Interview conducted by Caroline Lewis