Healthcare professionals aim to expand value-based care in Florida’s behavioral health sector


Shane Ersland


Value-based care aims to improve quality of care and lower healthcare costs, and professionals are working to expand the model in the behavioral health sector in Florida.


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Experts discussed those efforts at the Florida State of Reform Health Policy Conference. Florida Alliance for Healthcare Value President and CEO Dr. Karen van Caulil said it has been hard to adopt value-based care reimbursement models in the state. 

“We’ve worked with self-funded employers, and there has been a lot of pushback,” van Caulil said. “It’s been very frustrating for us to break down the barriers to move to delivery of care and appropriate payment, and make those reforms. About half of the arrangements in the commercial space are in some type of value-based care arrangement, but most of that is in physical health. We really think value-based care can help with the growing need in behavioral health.”

The alliance has discovered that healthcare spending is significantly higher for people who have mental health needs, van Caulil said.

“We see traumatic effects of the pandemic and isolation are coming down, but the need for mental health services is not coming down,” she said. “Employers have seen four times the utilization of services since the pandemic.”

Van Caulil discussed the collaborative mental healthcare model, a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. She said it can be hard for providers to get into these networks.

“It is much more likely that somebody who is seeking mental health services will have to go out of network,” van Caulil said. “When you talk to the health plans, they say it’s not hard. And we’ve talked to providers, and they say it’s really hard. Then once they get into the network, they find out how much paperwork they have to do to get paid an amount that they didn’t know until they got on the network. So we really have a lot of work to do in that space.”

Van Caulil said the collaborative care model aims to integrate behavioral health into primary care because there aren’t enough access points. 

“It can prevent suicide, overdose, [and] it has helped folks get to care a lot faster, [with] much better outcomes for patients who have been diagnosed with depression and anxiety,” she said. “Clinical studies have shown that the collaborative care model is the way to go.”

But provider reimbursement is not great in the mental health space, van Caulil said. 

CareNodes CEO Alex Yarijanian said it can also be hard to attract providers to the value-based care model because it is not incentivized sufficiently.

“What the state needs to do is put some incentives in,” Yarijanian said. “There are literally no incentives for performing. We could work with our payers and providers to establish a no-wrong-door approach, where the patient could walk into any door, whether it’s primary care, whether it’s the hospital, whether it’s perhaps even a behavioral specialist, that there should be no wrong door.”

These services should give patients direct access, Yarijanian said.

“However, if we don’t have a centralized way of monitoring these activities, we fall short,” he said. “That’s why the network and contracting strategy have played a critical role in bringing all these services together when they’re carved out.”