PRHI Shares Quality Improvement Model for I/DD Groups at Summit

Bruce Block, MD, Chief Learning and Medical Informatics Officer, PRHI; Carli Friedman, Director of Research, The Council on Quality and Leadership; and Patrick Maynard, PhD, CEO & President, I Am Boundless, Inc. at the 2019 I/DD Executive Summit.

Value-based reimbursement is creating challenges in developmental and behavioral health just as it has for physical health care providers. Intellectual and developmental disabilities (I/ DD) organizations are looking to make a smooth transition to this different payment structure. 

Value-based payment typically refers to symptom reduction, functional improvement, and overall wellness. Current reimbursements in the behavioral health sector have been based on number of visits, level of acuity, diagnosis, and service types – without requiring outcomes data. Payers will now begin to reimburse based on outcomes and value, which equates to reduced costs from their perspective. I/DD organizations will need to get on board.

Navigating this changing marketplace was the focus of the June 3 I/DD executive summit in New Orleans, attended by C-suite and director-level executives. The summit opened the four-day OPEN MINDS Strategy & Innovation Institute, which explores ways to developing innovative collaborations and productive partnerships among payers, health systems, and care management organizations. 

Dr. Bruce Block, Chief Learning and Medical Informatics Officer at the Pittsburgh Regional Health Initiative (PRHI), provided a blueprint of what quality improvement could look like when embedded in an organization. He emphasized the importance of collecting and using data to identify improvement opportunities for outcomes. While I/DD organizations regularly collect utilization data, few have adopted outcome measures that could support value-based payment. Successfully embedding quality improvement, however, would require leadership buy-in, a focus on organizational and client concerns, and a well-supported QI infrastructure. 

The good news: no I/DD organization need start from scratch. Block stressed that PRHI offers a range of resources and learning services to help in responding to this new demand.