September 16, 2019
The NC Medicaid Transformation is creating a shift from typical fee-for-service (FFS) payment to more value-driven reimbursement. Behavioral healthcare lags behind physical healthcare in this movement that emphasizes quality and outcomes over volume. To address this, i2i Center for Integrative Health has facilitated a Collaborative on Value-Based Purchasing with representatives from provider agencies, LME/MCOs and DHHS. The Collaborative agreed to recommend a pilot of Value-Based Care contracting under the new Community Support Team (CST) service definition (see story on new service definition).
This collaborative, made up of three LME/MCOs and three provider organizations, discussed current challenges preventing NC from expanding the use of value-based contracting. From this, the collaborative created the pilot proposal addressing Community Support Teams (CST). They chose CST because it is a service that can be strengthened with an approach that measures the quality of the outcomes for consumers, is a manageable service definition with a limited number of providers across the State, and because the service definition is changing to incorporate tenancy support management as of October 1, 2019 (for the State-funded services). The Collaborative considered several components for the proposed pilot including start-up needs, data and metrics to measure the value of the service provided, changes in financial processes, provider technical assistance, and the need for reduction in administrative burden.
NC DHHS leaders have given their thumbs up to the pilot moving forward and agreed to work together toward resolutions to outstanding challenges.