Does your organization have a plan in place to build and sustain your integrated behavioral health services? Do you know how you intend to fund your program in the next year? In three years? It is important to start planning early how to sustain and capture revenue for your integrated health care delivery model. As you plan for an integrated model of care, consider all the ways in which delivering effective integrated treatment will add value to your organization and can help your bottom line.
A narrow view of sustainability might only consider financing and billing, but there are other critical factors that play a key role in helping to develop, sustain, and continually refine an integrated model of care. Implementing a sustainable program requires three steps:
- Define and build a strong behavioral health integration model
- Define value broadly for your organization
- Understand the costs and revenues associated with your model
In an effort to help organizations understand the ongoing costs and revenues associated with integrated strategies, the AIMS Center created the Financial Modeling Workbook in collaboration with the Institute for Family Health and the American Psychiatric Association. The workbook can help organizations more accurately estimate revenues and expenses for providing collaborative care and other integrated services by:
- Estimating visit volume and the number of patients served;
- Defining and analyzing how much time staff engage in key integrated care tasks; and
- Estimating fee-for-service and G-code potential revenues more accurately
“This tool can be used in all stages of implementation to help clinics estimate the financial impact of each component of their program and model the cost of staffing or workflow changes in advance,” says Anna Ratzliff, MD, PhD, Associate Director for Education at the AIMS Center.
Organizations can also use the The Financial Modeling Workbook to more realistically evaluate the impact that integrated services have on their bottom line by evaluating parameters such as the length of appointment time and the percentage of time staff members spend on different tasks.
“The more accurate the information and estimates that you input into the workbook, the more likely the results will be meaningful to your practice and help you to create a long term plan to sustain and build your integrated program,” says Dr. Ratzliff. “The workbook allows you to input data to calculate what integrated staffing and strategies will cost and also allows you to project potential revenue sources, such as reimbursement from the CMS G-codes.”
The Financial Modeling Workbook is available for free by registering on the AIMS Center website.
The AIMS Center offers additional tools and resources to help organizations plan their integration strategies and anticipate costs, such as the Guidelines for Care Manager Caseload Size and sample job descriptions for behavioral health care managers and psychiatric consultants.
Planning for Sustainability: A Case Study
The St. Luke’s Health System, Idaho’s largest not-for-profit health system, began planning to launch a comprehensive collaborative care program in fall 2016. Before proceeding with hiring new clinicians, they developed a robust three-year sustainability plan by piloting the Financial Modeling Workbook.
“The Workbook was extremely useful for projecting revenue and budgets that weren’t already in place,” said Megan Stright, Director of Population Health at St. Luke’s. “We also were able to incorporate the CMS G-codes in our projections.”
St. Luke’s used actual historical data to populate the Workbook, estimating projected reimbursements and scheduling costs. Based on information about reimbursement and expenses for their current behavioral health professionals, who work in a small proportion of the clinics in their system, the Workbook allowed them to project revenue and expenses of the larger and more comprehensive integrated program that they envision. St. Luke’s will launch its program at three clinics in June 2017.