Serious mental illnesses (SMIs) are very costly to treat. Patients with SMIs also have much worse health outcomes.
Value-based care could help providers treat SMI patients better. It allows them to get creative and focus on the whole person. It includes physical, mental, and social well-being.
“Value-based care breaks the cycle of only providing reimbursable care,” says Sonia Garcia of Amae. “It allows for more holistic care that leads to true recovery.”
SMI has a huge financial and human cost each year:
- Over $300 billion in economic costs
- 10-20 year reduction in life expectancy for patients
Currently, physical and mental healthcare for SMI is very fragmented. Value-based care promotes a whole-person preventative approach instead.
“The current reimbursement model doesn’t support the comprehensive care SMI patients need,” explains Christina Mainelli of Quartet. It includes physical health, mental health, social services, employment support, housing, and more.
Companies like Quartet and Amae are using a whole-person approach for SMI care. Quartet recently launched a value-based model with multidisciplinary teams. It is moving further towards per-member-per-month and full-risk payment models for SMI.
Value-based care also enables beneficial wraparound services. For example, one Chicago insurer installed air conditioners in members’ homes during a heatwave. It cleared out overflowing hospitals overnight.
Peer support specialists are another key service for SMI patients. They can build trust with a population in the system that has repeatedly failed.
“Peers are essential for engaging SMI patients in care when doctors and nurses can’t,” says Samir Malik firsthand. His peer-based SMI care company enrolls 7 out of 10 patients they engage.
Peer services could also help with behavioral health staffing shortages. “Enabling reimbursement for coaching and wraparound services frees up providers to support higher-acuity patients,” notes Mainelli.
The tools to help SMI patients aren’t new—just the payment models. Value-based contracting could finally bring proven interventions to scale.
“We know what works for SMI,” says Malik. “We just haven’t aligned the economics to make it widely available. Value-based care changes that.”
