Doing More with Less: High Quality Care with Greater Efficiency

Staffing pressures have led to unprecedented financial challenges for behavioral health care provider organizations. Shortages of workers, coupled with wage inflation and stagnant reimbursement rates, are driving up costs in a landscape with more need than ever as autism prevalence rates continue to rise.¹

Market conditions have already led some major providers to stumble.² So, how can organizations meet the challenge of providing top-notch care while making the economics work? And for payers, how will they manage their networks to ensure adequacy?

While conventional supply-demand wisdom has many organizations and payers pushing for more providers, some, like Catalight realize that adding more of the same won’t solve the core problem. Instead, a quality-over-quantity approach, focused on innovations like new treatment options and technologies, can help organizations and payers do more with less and provide high-quality care at a greater value while enhancing access. The framework to help make this happen across stakeholders is value-based care (VBC).

Short-Staffed: The New Normal

Today’s behavioral health care providers expect staffing to remain a significant pain point for the remainder of the year, with workforce changes continuing to strain the bottom line.³ Staffing was voted the number one industry challenge in the 2023 Behavioral Health Business Industry Outlook, with 53% of the vote. That was followed by reimbursement and payment challenges, with 34% of the vote. In the report, staffing changes were also cited as the number one area of greatest financial strain.

Meanwhile, demand for Board Certified Behavior Analysts® (BCBAs®), paraprofessionals and other providers has continued to rise, along with the prevalence of autism and intellectual and developmental disabilities (I/DDs). And nowhere is demand greater than in California.⁴

It raises the question: If finding scarce and increasingly expensive staff is no longer a viable solution, how can payers and provider organizations deliver access and network adequacy in the face of staff shortages and increasing demand for care?

The Role of Value-Based Care 

Unlike physical care, behavioral health care remains largely modeled on fee-for-service rather than VBC. A lack of electronic medical records in behavioral health care means a dearth of data to inform best practices, outcomes and standards.

But that’s beginning to change, as payers and providers coordinate to standardize measurable, meaningful outcomes. Several states and organizations are testing VBC payment models that could be applied to behavioral health, including capitation, pay-for-performance and shared risk models.⁵

Debate about what are the right standards and outcomes continues. But the conversation is moving forward, driven in part by these staffing shortages and other financial pressures that have helped lead to clinical innovation.

A Blueprint for Payer Success

To succeed in optimizing network adequacy and serving members, payers should consider a different approach to network management and examine the assumption that more providers mean more access. A network that truly serves members is measured by more than headcount or ratio of providers; those numbers don’t really show quality care is actually getting to members in need. Instead, the path forward involves innovation in treatment options and effective ways to gauge the quality of care.

In autism therapy, the standard of care has long been three-tiered Applied Behavior Analysis (ABA) at up to 40 hours per week. The number of hours is costly, unsustainable for many families (and for current market conditions) and is not necessary for meaningful progress.

Research has shown emerging new treatment options can be just as effective while providing efficiency and other benefits. For example, Parent-Mediated ABA, a core offering of Catalight’s, has been shown to be as effective as practitioner-led ABA⁶ and offers other benefits. In addition to supplementing practitioner-led ABA, potentially reducing provider hours per client, Parent-Mediated ABA has been shown to increase parental self-efficacy and reduce stress.⁷

Catalight offers other Parent-Mediated treatment modalities, including Chat and Connect, in which highly trained clinicians teach parents to help their children with naturalistic language and skills development. Calibrate is another parent-mediated offering focusing on reducing dangerous and challenging behavior.

Key to a value-based care framework are outcomes and quality standards. But measuring outcomes in behavioral health care is more complex than in physical health, where biometrics like hemoglobin A1C for diabetics, for example, are a reliable measure of how well a given treatment plan is performing.

Client and member satisfaction are important metrics, but what measures treatment effectiveness? Many existing instruments focus on reduction in outward behaviors, such as hand-flapping or rocking. But is a reduction in this behavior a reliable indicator treatment is giving the client a better quality of life, given it may be a self-soothing behavior?

Catalight has introduced proprietary Wellbeing Scales: one for children, one for caregivers and one for adults. Wellbeing is an expression of quality of life, a measure that carries across the highly diverse autism population. Wellbeing is defined as the measure of a person’s overall happiness, satisfaction with life and positive outlook on life. While existing quality-of-life scales do exist, some have been found to be problematic because of gender bias, for example.⁸

Last, payers should partner with an organization that can help them change how they define and tackle network management. Catalight has extensive experience in value-based contracts and achieved results like a 37% reduction in costs, while averaging referral-to-appointment wait times of only four to seven days. Rather than simply throwing more providers at the problem, Catalight has focused on clinical innovation backed by real-world data from more than a decade of providing care for the autism and Intellectual and Developmental Disabilities (I/DDs) communities.

One of the nation’s largest behavioral health networks, Catalight’s Advanced Care Solutions offers multi-modality care is designed to increase access while driving down the cost of care and improving outcomes. Its commitment to value focuses on improving the wellbeing of people with developmental disabilities and their families, while also lowering costs.

^[1] Data & Statics on Autism Spectrum Disorder
^[2] Autism Therapy Companies to Watch in 2023
^[3] 2023 Behavioral Health Outlook
^[4] US Employment Demand for Behavior Analysts 2010-2022
^[5] Value-based payment models in ABA: Preparing for value-based payment models in applied behavioral analysis
^[6] Treatment Efficacy of Parent-Mediated ABA for Children With Autism and Their Parents
^[7] Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial
^[8] Assessing general and autism-relevant quality of life in autistic adults: A psychometric investigation using item response theory