Unlocking Success in Value-Based Care:

The Critical Role of Compliance in Behavioral Health
October 11, 2023 by
Simplifyance, Gina Thorne

The behavioral healthcare landscape is undergoing a profound transformation, with a growing emphasis on value-based care. In this new era of mental health and substance use disorder delivery, providers are incentivized to deliver high-quality care efficiently, and compliance plays a pivotal role in achieving this goal. There is a growing discussion happening among behavioral health compliance experts widely recommending that providers focus on several key areas to thrive in a value-based care environment. In this blog, we'll explore the critical aspects of compliance that providers should prioritize for success.

1. Environment of Care

Creating a safe and conducive environment for patient care is fundamental to value-based care success. Compliance experts stress the importance of ongoing monitoring and adherence to safety standards and regulations. Ensuring that facilities are well-maintained, sanitized, and equipped with necessary safety measures not only safeguards patients but also contributes to positive patient experiences.

2. Clinical and Medical Documentation

Accurate and comprehensive clinical and medical documentation is the bedrock of value-based care. Compliance experts advocate for meticulous record-keeping, including patient histories, diagnoses, treatment plans, and outcomes. Detailed documentation not only aids in providing quality care but also supports billing accuracy and compliance with regulatory requirements. 

3. Audits

Regular audits are essential to ensure that healthcare providers are adhering to compliance standards. Compliance experts advise implementing an internal audit program to identify and rectify potential issues proactively. These audits can encompass a range of areas, including coding accuracy, billing practices, and adherence to clinical guidelines.

If time or staff shortages are factors in completing chart audits, Simplifyance offers Chart Insights, a special package to help providers stay on top of their audit management. 

4. HR Documentation

Human resources (HR) documentation is a vital but often overlooked aspect of compliance. Compliance experts stress the significance of maintaining accurate and up-to-date HR records, including employee credentials, certifications, and training records. Proper HR documentation not only helps in compliance but also contributes to a skilled and qualified workforce.

5. Patient Outcomes

Ultimately, the success of value-based care is measured by patient outcomes. Compliance experts emphasize the need for providers to focus on achieving positive patient outcomes as a core objective. This involves following evidence-based practices, monitoring patient progress, and continuously improving care delivery to enhance patient well-being.

To understand more about the importance of patient outcomes and to consider joining other providers in the industry, visit NAATP FoRSE Outcomes to learn how your organization can be a part of this important study.

In conclusion, compliance is the linchpin of success in the transition to value-based care. Payors and regulators are moving more toward value-based care and requiring further outcome data to demonstrate treatment methods that will provide the highest level of success. 

Providers must prioritize compliance in the environment of care, clinical and medical documentation, audits, HR documentation, and patient outcomes. By doing so, behavioral healthcare organizations can not only meet regulatory requirements but also deliver higher-quality care, enhance patient experiences, and thrive in the evolving behavioral health landscape.