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Exploring the Behavioral Health Independent Practice Association in an Era of Managed, Value-based Care

Editor’s Note: HMA Principals Karen Batia, David Bergman, Meggan Schilkie and Senior Consultants Meghan Manilla and Nicola Pinson contributed to this post. 

Across the country, behavioral healthcare is stretched thin and access to specialty care is a challenge. As value-based payment makes its way to the forefront, more than ever government entities, providers, payers and community-based organizations are exploring new avenues to meet shifting priorities and the requirements that accompany them.

HMA is working with clients from coast to coast to address these challenges and take advantage of opportunities presented by redesigning organizational structures, forging new partnerships and streamlining operational functions – all through the lens of providing quality care. While there is no one-size-fits-all model or solution, the behavioral health Independent Practice Association (IPA) is increasingly an option being explored and embraced.

Traditionally used by groups of physicians and independent practitioners, IPAs can take various forms. Today, many groups – including small to large community-based behavioral health organizations – are joining together to form these behavioral health networks, sharing ownership and risk while leveraging resources and negotiating power as they strive to improve health outcomes and streamline operations in an age of managed, value-based care.

HMA’s experts, including our team of clinician consultants, have helped numerous clients explore the possibility of creating an IPA. Currently, we are working side by side with clients ranging from large counties and health plans to behavioral health associations and community-based organizations to develop and implement IPAs. While each IPA is as unique as its entities and the populations they serve, there are some universal challenges, opportunities, and issues that all IPA members grapple with, whether they are in the planning stages or putting their plans into action.

Partnerships

HMA helps behavioral health providers navigate the major systems reform efforts happening across the country. As providers explore their options for not only surviving, but thriving in the future, they usually determine it all starts with partnerships.

IPAs are often attractive to providers because they offer the benefit of forming partnerships to provide a more comprehensive continuum of care while still maintaining some of their own unique identity. As part of a network, individual entities – especially those that are smaller –find they benefit from an infrastructure that simply wasn’t possible while operating on their own. Those benefits range from the clinical to the financial, including the ability to leverage the bargaining power of a network in negotiations with MCOs.

 

Of course, it’s not just about partnerships. It’s about the right partnerships. And, there is no one way to form partnerships and usually no linear path. Planning and coordination are critical – and complicated. Technology provides its own set of challenges. And as networks form, members have to become accountable for the quality of each other’s services.

Governance Infrastructure

Creating the IPA’s governance infrastructure is often one of the biggest challenges its members encounter. It forms the basis for all other activities and operations. Determining exactly how these new relationships will be formalized can be tricky – from creating processes to avoiding legal pitfalls.

Members will need to navigate numerous options and hurdles when determining the organization’s structure and mapping out exactly how it will function. Central to everything they will encounter is the ability to develop relationships with one another, establishing trust and cultivating collective goals that benefit the IPA and all if its members.

Clinical

Members need to develop a clinical model for the network. Establishing a network of care is a fundamental shift, and it’s important that members identify the different levels of need among their populations, so they can then design interventions to address those needs – improving outcomes and meeting quality measurements.

During this process, it’s imperative that members determine how their network will do things differently than they would as individual organizations. What do they bring to the table as a network that is different and of greater benefit? An IPA also must select what metrics will be used to measure success and ultimately demonstrate the value of the network to managed care plans.

While development of the clinical model is taking place, members must also establish the financial model that will support it.

Technology

It’s not just the technology an IPA will use, but how that technology will be used. This is a challenge for individual entities. When dealing with multiple members – which could number in the dozens – at various points along the spectrum of health IT knowledge and utilization, that challenge rises to new heights.

IPAs must identify solutions that aren’t too far of a reach for less sophisticated practices when paired with the proper support and still provide meaningful value to more tech savvy members. And beyond the tools themselves, it’s shifting their use to operate within the context of population health which is often a fundamental shift in approach for how practices function at the clinical level.

HMA Can Help

From inception to implementation, HMA’s diverse team of experts can help organizations navigate the complex realm of IPAs. We help clients with:

  • Strategic planning
  • Partnership assessment and facilitation
  • Establishing governance structures including legal and partnership agreements
  • Developing organizational infrastructure
  • Developing and supporting clinical models and standards
  • Developing and supporting financial models including value-based payment arrangements
  • Assessment of organization readiness to take on value-based payment contracts
  • Training and technical assistance including webinars and learning collaboratives for ongoing practice transformation through coaching
  • IT purchasing and implementation, including data warehouse, business intelligence, and electronic health record interfaces
  • Contracting between IPA members
  • Contracting with MCOs
  • Establishing performance standards for IPA members
  • Member notification and engagement

To learn more about how we can help your organization, contact Karen Batia at kbatia@healthmanagement.com.

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