System Redesign Part III: A View From the Balcony

Author: Megan MacDavey

This is the third in a multi-part blog series. Catch up with Part I here and Part II here.

A view of a theatre stage in a darkened auditorium, with rust-colored curtains lit by spotlights.In the adaptive leadership framework, “getting on the balcony” is the idea that, when met with complex challenges, you leave your world on-the-ground – your deadlines, to-do list, and distractions –and look at the big picture for some added perspective and reflection. I think conferences are the perfect opportunity to get on the balcony, and I have the privilege of working at a Foundation with a commitment to my professional development, as well as the resources to dedicate to it.

In this spirit, about a month and-a-half ago I attended a conference put on by Open Minds, a market research company that concentrates on individuals with complex needs. The conference focused on how critical it is for health and human service organizations to reposition themselves for success in the new payment reform landscape. I walked away with so many takeaways, but I’ll share just some of the big ones here:

  • Big picture:
    • Organizations serving individuals with complex needs, like those with mental health challenges, intellectual disabilities, and substance use disorders, are being left behind.
    • Identifying excess cost is more common on the physical health side of the house, and therefore easier to recapture in the physical health space. As a result, insurers have not found an effective way to spread those savings to behavioral health or IDD providers.
    • It’s hard to articulate the value of services provided for children as most of the financial payoff happens later in life at which point it is hard to draw a direct line back to those services.
    • Knowing what you are good at is critical. Stratifying your clients by level of risk, teasing out the services and costs of services for clients with different degrees of need, can position organizations well for conversations with payers.
  • Organizational infrastructure:
    • At a time when everything feels like a gamble, there are a few investments that are not:
      • Technology;
      • Data analytics (systems and people);
      • Developing and nurturing a data culture (one that embraces data, uses data to drive decisions, and improves through data reflection); and
      • Having the right people on your team.
    • Human resources talent should be regarded as important as your COO or CFO.
    • New skillsets are needed in this time: creativity, less adversity toward risk, and willingness to work across systems. Some people are no longer going to be the right people to propel your organization forward.
  • Emerging trends:
    • In addition to hospitals and other health care entities building out their own behavioral health services, payers are also beginning to provide services.
    • There are so many new and emerging players in the behavioral health care field, including many that are exclusively tech-based. Pay attention to the innovation happening with artificial intelligence and technology in the health care field.

From a funder’s perspective I left the conference with so many questions: What are the regulatory barriers that may stand in the way of our grantees succeeding in this new climate (e.g. implementing telespsychiatry, collaboration between agencies)? Are the fields of behavioral health and intellectual disabilities viable to stand on their own in the future? How can we, as a foundation, stay informed, but not get consumed or overwhelmed by the minutia? How do we use our limited capacity building funds in a way that supports this new world? How can we foster creativity – internally and externally with our grantees?

Despite my questions, I also left the conference feeling excited. Even with all of the changes to the delivery system (and knowing how hard and scary change can be), it is not all doom and gloom. Yes, there will be winners and losers in the transition to Value Based Reimbursement. But we might (hopefully) emerge from this period of transformation in a better place than where we are today.

Want to chat about VBR? I would love to hear from you.