Lynn Carroll is COO and head of strategy at HSBlox, an Atlanta-based technology company empowering healthcare organizations with the tools and support to deliver value-based care (VBC), successfully and sustainably. He is a high-energy business professional who launched a successful healthcare payments platform business in the infancy of HIPAA compliance and helped lead its growth through the ACA and beyond. An expert in value-based contracts, bundled payments, P4P and global reimbursement, alternative payment models, episodes of care and contract administration, Carroll possesses an in-depth knowledge of the healthcare insurance and integrated payments ecosystems. Among his successful launches: enterprise solutions for premium invoicing and collection, digital payments, patient financial engagement, prospective bundled payments, and value-based contract administration.
In today’s interview, we explore primary care-behavioral health alignment and its importance to patient outcomes.
Q: Why is aligning primary care with behavioral care so critical?
A: Aligning primary care with behavioral health care is vitally important because behavioral health has a demonstrable impact on clinical outcomes. Underserved populations such as rural Americans are at a particular disadvantage in this regard because behavioral health support and services either are unavailable, not integrated with their primary care, or not covered by their insurance.
More than anything, this lack of alignment creates health inequity issues for rural and low-income Americans struggling with social determinants of health (SDoH) that pose barriers to care. So while the prevalence of serious mental illness and most psychiatric disorders among adults in the U.S. is similar in rural and urban areas, Americans living in rural locations receive mental health treatment less frequently than those residing in metropolitan locations. And even when these underserved populations can access behavioral health care, it’s often with providers who lack specialized training.
Unfortunately, it can be difficult for low-revenue providers in rural areas to integrate primary care with behavioral care because they lack funding. Another integration barrier is the shortage of qualified behavioral health professionals in their geographic areas.
Q: How do Social Determinants of Health factor into this alignment?
A: Lack of integrated care combined with SDoH-related access limitations can prevent adults living in underserved rural populations from receiving mental health treatment. SDoH factors create obstacles that can prevent vulnerable populations from getting the primary care or behavioral health care they need.
These social determinants include transportation and language barriers, lack of employment and insurance, racism and other forms of discrimination, and lack of digital access, which can preclude telehealth services.
One of the things CMS is trying to address is improving SDoH data capture and sharing. Better data capture and sharing can give providers a clearer picture of the challenges facing the populations they serve, making it easier to devise successful mitigation strategies. SDoH data capture and data sharing will be an integral part of the care transformation the Centers for Medicare and Medicaid Services (CMS) is trying to stimulate going forward.
Q: Tell us about the CMS ACO Primary Care Flex Model and how it might help.
A: CMS created the ACO Primary Care (PC) Flex Model to address health equity and drive better outcomes for underserved populations by increasing access to higher-quality primary care and promoting more innovative, team-based, and equitable approaches to care. Under the PC Flex reimbursement model, care can include unique services such as behavioral health integration.
The model, which goes live on Jan. 1, 2025, includes a Prospective Primary Care Payment (PPCP) option that will shift reimbursement for primary care away from the traditional fee-for-service, visit-based payment. PPCP includes components that make it attractive to accountable care organizations (ACOs) with Federally Qualified Health Center and Rural Health Clinic participants.
An ACO’s PPCP rate, for example, can be based on its average county primary care spending rather than on its historical spending. This enables providers with entrenched patterns of inappropriately low spending for underserved areas and populations to be paid more. The PPCP also includes payment enhancements and adjustments to the county rate, providing additional resources to providers caring for underserved populations.
By ensuring more healthcare dollars go toward underserved populations, the PC Flex model provides primary care practices with the flexible funding needed to improve care coordination and identify and address people’s unmet health-related social needs.
Q: To what extent can digital infrastructure help with the alignment we’ve been talking about?
A: An outdated or insufficient digital infrastructure can make it virtually impossible to align primary care with behavioral health services. Overcoming this technology barrier requires implementation of a scalable, cloud-based digital infrastructure that supports a many-to-many network of participants.
Such a care network may include behavioral health providers and community-based organizations (CBOs), many of which have low digital capabilities but expect and rely upon frictionless reimbursement. Cloud-based networks connecting multiple participants can eliminate silos and facilitate the efficient sharing of information required to ensure care alignment and coordination.
In addition, a robust analytics platform running on top of a scalable digital infrastructure can provide transparency into performance, which is essential to ensuring the success of value-based care (VBC) contracts.
Q: What does true collaboration look like and is it even possible?
A: There always will be challenges to collaboration when you’re dealing with multiple organizations that have differing levels of digital competency. Nonetheless, true collaboration not only is attainable with the right strategies and technologies, but also is absolutely necessary if we are to attain the goals of VBC and align primary care with behavioral care.
Collaboration between primary care providers and behavioral specialists is critical to whole-person health. Reimbursement models that align primary care with behavioral health services offer low-income provider organizations serving rural Americans and other vulnerable populations an opportunity to improve coordination, improve outcomes, and generate much-needed revenue.
To fully align primary care with behavioral health services, care organizations need a scalable digital infrastructure that can handle the demands of a many-to-many collaborative care network. This will allow primary care providers, behavioral health organizations, and CBOs to easily and securely share information and patient data in a way that enhances care while controlling costs. That is what true collaboration will look like.
