By | July 3, 2019

Taking the First Step is So Hard

I have been dreaming, planning and getting ready to get started on doing nothing for a while. I am planning to retire. I have never worked so hard at not working in all my life. And I haven’t even started yet. I have thought about it, talked about it, dreamed about it and lamented on how hard it is to take a step toward retirement but I haven’t yet taken the first step. Why?

I’ve thought about my “stuckness” while looking at the industry in which I am stuck—behavioral healthcare. News Flash: We know that treating behavioral health and addressing person’s social and economic disparities has the greatest impact on overall health and functioning. Behavioral health and social determinants (e.g., social isolation, poverty) left unaddressed add 2 to 3 times the cost on the total cost of care. So why is it that not even 10% of behavioral health providers have fully leveraged (defined as greater than 20% of total revenues) a value-based contract based on this known fact– one in which they have a strong value story that could drive additional revenue for their agency resulting in more and better care for their consumers?

Change Is Hard

Why? Change is hard. And changing how we do business is even harder. The MIT 2017 Change Model of the Year says that for change to occur, three simultaneous levers—personal, social and structural—must be addressed. In other words, knowing what’s in it for the individual, how the individual or body compares to peers and having structural supports to focus attention on what is most important must be fully activated to get started with a change process such as value-based contracting.

If you work in behavioral health and you are stuck in “talking but not doing,” I offer these tips built on the MIT Change Model:

1) What Is the Win?

First, determine what is the win to get key staff—particularly senior leaders and clinicians—activated in the change process. Know what is “in it for them.” What do they care about most? What does your agency collectively excel in and care about most? How does this alignment of individual and collective passion and excellence align with your overall mission? And how does this collective passion, excellence and mission link to your payers’ needs and wants such as access, total cost of care reduction, and/or emergency room or hospital diversion? You have now identified personal and collective reasons to motivate change.

2) How Do You Stack Up?

Second, how do you compare to your peers? What data do you have and what data-driven story can you tell the payer about your excellence, how it stands out from others and how it can be leveraged by the payer to assist them with what is most important to them—their financial bottom line? Do you have same-day-access statistics? Do you have a story about crisis diversion or other services that reduce unnecessary use of the emergency room? Having a comparative financial impact story that sets you apart from your peers is your differentiator to start a discussion with a payer.

3) Do You Use Your Data?

Third, what data and technology structural supports do you have, or need to focus on, and what is most important for your “win” in value-based contracting? Put the data story and the goal in front of your key staff regularly to drive attention and focus to the change goal. To engage in value-based contracting you may need to take some risks, for example, lowering your unit rate while earning more than the differential in a bonus if you meet the performance outcomes. You must be able to see these performance targets and guide your staff visually for daily “nudges” to focus attention and action on what is most important to create the continuous value story. We know from behavioral economics that pointing people to what you want them to pay attention to and showing them how they are doing against goals compared to others is one of the most cost-effective methods to start a change process.

Let’s get started. Discover how Relias can help you get started with a successful value-based business model. As for me, I am taking the first step toward my retirement goal. I am going to work a 40-hour workweek for the first time in about 15 years. Good luck to us both!

Carol Clayton, PhD

Carol Clayton, PhD, is a licensed, practicing psychologist with 30 years of healthcare experience in the public and private sectors, including non-profit and private practice work. Before joining Relias, she served for four years as the CEO of Care Management Technologies (CMT), a health IT data analytics company acquired by Relias that serves as a foundation to the evolving Relias performance management platform. Prior to her tenure at CMT, Carol worked at the executive level with Merit Behavioral Health Care (now Magellan Total Health Solutions) and as the Executive Director for the NC Council of Community MH/DD/SA Programs during the transformation of public sector services to managed care behavioral health.

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