March 23, 2019, marked the ninth anniversary of The Patient Protection and Affordable Care Act (ACA) being signed into law. These past nine years have been a continuing debate regarding the various aspects of health insurance reform contained in the ACA.
The most fundamental of reforms arose out of the simple definition of “essential health benefits.” For the first time in our nation’s history, health insurance plans were obligated to include “mental health and substance use disorder services, including behavioral health treatment” as covered benefits in their policies.
Behavioral health (BH) providers, who previously had very little exposure prior to the ACA, have been on a sharp learning curve when it comes to dealing with commercial payers.
However, much to the surprise of the BH community, payers are running toward alternative payment models that have been commonly utilized in BH for decades. Capitation and risk arrangements are a way of life for BH providers. Capitalizing on this knowledge is critical for any primary care physician (PCP) looking to integrate BH into his/her practice.