The Business Side of Behavioral Healthcare

December 16, 2019 uurilklt 0 Comments

Rates of anxiety, depression, suicide, addiction and substance misuse are at all-time highs. In 2016, more than 44 million Americans experienced a mental health issue, and 19 million suffered a substance use disorder; 8 million people experiencing both. Over the last 10 years, more than 1million lives were lost to drugs, alcohol or suicide. The U.S. now spends over $400 billion annually on mental health, including of the cost of care and the loss of productivity to our economy and society, making it the costliest preventable medical condition in the country.  

The Triple Aim model whose purpose is to enhance the U.S. healthcare system requires achieving three interdependent goals: improving the experience of care, improving the health of populations, and reducing the per capita costs of health care. There is an immediate and urgent need to expand Americans’ access to affordable and high quality mental health care and addiction treatment services, and especially in underserved populations.

Since the introduction of managed care models in the U.S. healthcare system in the 1990s, there has been an ongoing tension between those parties representing the clinical side of healthcare that focus on addressing patients’ clinical care needs, and those representing the business side of healthcare that focus on addressing the financial needs of healthcare delivery systems. This dichotomy is both artificial and untenable. 

Despite the intentions of so many well-meaning mental health professionals, the current barrier of insufficient access to quality mental healthcare services is in part the result of pervasive inefficiencies inherent in behavioral health organizations’ clinical and business operations, an
absence of strategic frameworks to drive growth, and failed policies and practices that often render provider groups financially unsustainable let alone capable of expanding service capacity to meet broader population healthcare needs.

When a behavioral healthcare organization is faced with cashflow management challenges, one consideration is to partner with a consulting firm that specializes in facilitating process improvement through enhanced reimbursement models, optimized clinical delivery systems, efficient business operations, and strategic organizational initiatives. A revenue cycle management (RCM) company can serve as a valuable asset for maximizing income. A comprehensive scope of revenue boosting services from RCM companies may include patient benefits verification, prior authorizations, initial and concurrent reviews, charge capture, claims and denial management, effective payer contract management, collections, and provider credentialing, all of which are crucial to ensure proper clinical, operational and fiscal functioning. 

One should strive to retain revenue cycle management professionals that have proficiencies specific to behavioral health. The degree to which these consultants also can bring expertise and deep experience in behavioral health services delivery systems design and management, as well as organizational behavior management and transformation, decreases the likelihood that implementation of revenue-related operational changes will adversely impact the overall functioning of the organization.

In parallel, a consulting organization that can help eliminate revenue leakage and enhance revenue integrity nicely complements efforts to improve revenue capture processes. The course of reducing leakage and shoring up systems that foster revenue stability may include addressing a variety of operational components such as referral, intake and scheduling processes, the overall scope of programs and services, application of best clinical practices, organizational leadership and communication, strategic planning and decision-making, human capital and performance management, data management and systems integration, documentation and compliance, payer relationships, and utilization management. Moreover, all these factors must be solidified and optimized if the organization eventually intends to scale.

As a boutique consulting firm, we advise the behavioral healthcare community on the strategies and resources needed to foster growth. Our assessment model is client-centric, data-driven, multidimensional and inclusive. We apply an integrated approach to help behavioral healthcare organizations maximize cashflow and minimize the dollars that otherwise would be left on the table absent optimizing clinical and business operations. This may be achieved through a combination of clinical services expansion strategies, elimination of friction points and misalignments in clinical service delivery and organizational management systems, as well as upgrading revenue cycle management services. We believe that this form of organizational transformation represents a crucial step towards expanding access to behavioral health services to help address the mental health crisis in America.