IDD and Behavioral health providers want to improve their connection to the healthcare system overall. However, that may bring new issues and challenges to achieve.
We’ve seen trends develop throughout 2018 with varying degrees of impact. More than likely the intensity and cadence of these trends will heighten throughout 2019.
Consolidation
Mergers and acquisitions are expected to continue in the fragmented behavioral health landscape. Private equity firms with platform deals will seek to build out their portfolios more strategically in 2019, looking for smaller targets with potentially lower multiples that will fill service gaps in the continuum of care.
But for-profit isn’t the only sector seeing activity. Given the increasing pressure on Medicaid reimbursement, non-profit organizations are looking to merge or possibly be absorbed.
The need for agency fiscal sustainability is more important than ever.
Compliance with multiple regulations
As state and federal leaders grapple with the opioid crisis, many are beginning to open their eyes to the regulatory environment surrounding addiction treatment. Patient brokering, black-hat marketing and profiteering will be subjected to increased attention. In fact, a group of bipartisan House leaders has been actively investigating patient brokering for the last several months, gathering information about state regulations and hosting committee hearings on the matter.
However, there’s an opportunity for the industry to self-police in a meaningful way before new regulations emerge.
Competing as a low-cost provider
Healthcare costs in the United States are expected to rise 5.6% next year. In the meantime, care and coverage are becoming unaffordable for consumers, especially as their out-of-pocket costs rise. Being a low-cost provider could offer some organizations an advantage, especially in the absence of methods to validate the high value.
Being low-cost doesn’t mean cutting corners, but rather, it’s about economics and efficiencies, such as smooth transitions between levels of care, a technology backbone and revenue cycle management. Consumers and payers will be looking for good deals.
Expectation of outcomes
Not only will payers of all types ask for outcomes data, but consumers will also be looking for ways to compare the “best” agencies and treatment centers.
Outcomes data also can help payers rationalize the payment structure—something they’re lacking
currently—which can help reduce coverage denials and boost reimbursement.
IT will drive decisions
Health IT is more than just using an EHR to document care. Deep analytical dives can reveal clinical opportunities for quality improvement, and data will be integral to the seemingly inevitable shift toward value-based payment models and lower-cost client care.
Other IT must-haves will include telehealth and digital platforms to expand the reach of clinical teams in shortage areas and to cater to consumers who are looking for convenience. Apps and online interfaces will serve to maintain engagement between outpatient visits while also serving as tools to track outcomes more regularly.