We know what it should look like, now it’s time to ‘get on with it’, according to the Centre for the Health Economy.
With health ministers meeting today to address the national mental healthcare crisis, it’s time to “get on with [value-based payment]” in mental healthcare, say experts.
In 2022, the Australian governments signed the National Mental Health and Suicide Prevention Strategy, with a promise to shake up mental healthcare.
But while the reform is under way, it seems there is still a way to go.
Speaking to Health Services Daily, chief investigator for Macquarie University’s Centre for the Health Economy, Associate Professor Jonas Fooken said that while how a health system should function was well established, making steps towards that ideal was a tougher ask.
“Ideally, what [a healthcare system] should be paying for is health improvement,” he said.
“This goal has been recognised for a very long time, but it is very difficult to then say, ‘let’s move on from that realisation and undertake some next steps to introduce value-based payments into the healthcare system’.”
In an attempt to build on the previous recommendations of the of the Productivity Commission Inquiry into Mental Health, the Royal Commission into Victoria’s Mental Health System and the 2030 vision outlined by the National Mental Health Commission, the CHE yas released a report collating previous research with stakeholder input on how to get better value for money in mental health care.
The paper outlined two key reform objectives, their rationale, an outline of barriers and recommendations of short term (1-2 years) and medium term (3-4 years) actions: the introduction of value-based payments and a new “unified, national” investment approach and effectiveness evaluation process.
Currently, mental healthcare provision and payments in Australia, and healthcare more generally, are almost exclusively per service, or process based.
The report supported movement towards “value-based” payments in mental healthcare.
In terms of what a value-based payment model would look like in practice, the paper looked to a newly formed independent authority to define the intricacies of a national approach across both mental health and physical health.
Once realised, by the Independent Value Based Payment Authority, the model should be implemented by governments through PHNs, LHDs, a combination of both, or by independent regional commissioning agencies as described by the Productivity Commission, said the paper.
Professor Fooken said, for him, the major takeaway from the research was the need to “get on with it”.
But while there may be consensus on the potential merits of value-based care, according to the report substantial barriers remain.
Dr Fooken said that many of the potential barriers posed by stakeholders were just that: potential.
“All the issues that were raised [by stakeholders] were primarily issues that we don’t know much about because we haven’t tried [value-based payment],” said Professor Fooken.
“So, what would be my personal primary takeaway, and next step, is to identify one area of mental health, ideally, and then try to introduce these payments.”
Dr Fooken acknowledged that identifying an area on which to pilot value-based payments was a challenge and was not clear from the research, but starting at either the lower or higher end of the needs spectrum could be an option.
While lower needs may be simpler, the upper end was “resource intensive” so may see greater value more quickly.
But, he added, mental health, rather than physical health, was a good place to start.
“Mental health is a good place to start with value-based care, because … the fact that mental health is so multi-dimensional and often comorbid with physical health symptoms, it needs a very comprehensive approach,” he said.
“That makes the definition of value very complicated, [but] also forces [policy makers] to solve the problems of value-based care.
“If you find a solution for the big problems in mental health, [you’re] done.
“The problems are going to be slightly different in physical health conditions, [but] usually they’re going to be of lower complexity.”
The report also proposed a new “unified national” approach to investment and evaluation which incorporated evaluation from providers, those with lived experience and governments.
The proposed independent expert committee would be supported by three subcommittees: lived experience, clinical and economic.
In the name of transparency, all recommendations from the committee would be public.
Government stakeholders raised concerns over the integration of the body with current federal processes.
The researchers recommended actively involving evaluators, and consumers, in the conception of new models of care.
Professor Fooken will be presenting the report for the National Mental Health Commission at the upcoming Australian Health Economics Society conference on19-20 September in Sydney.
Making moves to improve mental healthcare across New South Wales, Assistant Minister for Mental Health and Suicide Prevention Emma McBride has today announced four new free walk-in mental health support in Blacktown, Campbeltown, Broken Hill and Central Darling regions of NSW.
The Medicare mental health centres will provide extended hours, “wrap-around” care from a multidisciplinary care team including social workers, nurses and peer support workers.