Latest / Becker's Healthcare Behavioral Health / The Business of Care: Elevating Behavioral Health Reimbursement with Purpose

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The Business of Care: Elevating Behavioral Health Reimbursement with Purpose · Becker's Healthcare Behavioral Health

• 0:00
  Hi, everyone. Thank you so much for listening
• 0:02
  to this episode of the Becker's healthcare podcast
• 0:05
  series. I'm Erica Carbajal, an editor with the
• 0:08
  Becker's hospital review news team.
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  Today, we're gonna be talking about elevating behavioral
• 0:13
  health reimbursement
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  with purpose.
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  Joining me for today's discussion is Kevin Isaacs,
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  founder and president of Tribunus Health. Kevin, thank
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  you so much for being on. It's a
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  pleasure to have you. Absolutely.
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  Pleasure to meet, Lucido.
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  Yeah. Well, Well, to get us started here,
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  do you mind sharing a little bit about
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  yourself, Trebonus Health, and the scope of your
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  work in health care? Yeah. Of course. So
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  like you said, I'm I'm Kevin Isaacs, president
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  of Trebonus Health, and, you know, we we
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  help providers
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  negotiate better rates with payers.
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  That's what we do ultimately
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  through their contracts with those companies. So, you
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  know, when a provider or a facility group
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  brings us on, they can expect not only
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  the best outcomes with those payers, but also
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  the best client experience, and that stems really
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  from our teams.
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  And behavioral health specifically, you know, we've got
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  multiple leaders with two to three decades of
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  experience
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  conducting these negotiations,
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  which makes a big difference both in terms
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  of, you know, their Rolodex
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  and just how the what to do next
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  as as different offers and counters come through.
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  And, you know, the wrinkle here for us
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  is really that we do it in a
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  very data informed way,
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  which has not been the norm in our
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  space.
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  Yeah. For sure. Thanks, Kevin. Super
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  relevant topic, obviously. I mean, we continue to
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  hear and report a lot about parity when
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  it comes to reimbursement with with mental health
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  and the lack of of access to care
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  in part because of that. I know mental
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  health is a deeply personal issue for many,
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  including
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  yourself.
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  So can you share a little bit about
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  what motivated you to start Tributus Health? How
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  have your personal experience
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  really shaped the company's mission to serve mental
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  and behavioral health providers?
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  Yeah. Thank you for asking. I mean, for
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  me, like, by the age of 27,
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  I'd add
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  three close friends
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  who suffer from mental health issues pass away.
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  I remember my parents,
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  at the time, you know, this happened from
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  the ages of 17 to 27.
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  I remember my parents not really having anything
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  to say about it. And that made me,
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  like, mad at but I realized they had
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  not really had those experiences themselves.
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  Kind of a glass shattering moment in the
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  parent child relationship.
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  But I think it was emblematic
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  of, you know, a culture where you just
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  didn't talk about it.
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  So kind of with that simmering as a
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  backdrop
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  and, you know, the truism in my in
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  my business brain that health care was broken,
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  quote, unquote,
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  I set out to understand
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  what the different problems that providers were facing,
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  and how that impacted care delivery.
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  Payer contracting really stuck out to me. There's,
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  you know, a lot of things that I
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  think the sort of average provider based business
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  could improve on, but payer contracting really stuck
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  out. It was a near universal need
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  that was largely going unfilled on the provider
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  side at least. Meanwhile, you had access issues
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  on the patient side,
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  driven in no small part by the financial
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  barrier to care, that, you know, you kinda
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  referenced earlier.
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  And then from a supply perspective,
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  you know, the majority of negotiation experts out
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  there were kind of one off,
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  without the resources
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  to to really represent providers effectively.
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  Yeah. Kevin, thanks thanks for sharing that. Certainly
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  representative
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  of just how much has shifted to over
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  over the years in terms of awareness and
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  and openness and talking and seeking help when
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  it comes to behavioral health care as well.
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  Yeah. I I think,
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  you know, all those factors
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  contributed to, like, a a power imbalance
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  that
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  was and still is threatening the independent practice
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  of medicine.
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  You know, you think about sort of the
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  consolidation taking place, both, you know, with hospital
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  systems, but also, you know, payers who are
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  buying provider groups. And that dilutes the market
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  mechanism that's supposed to be the linchpin of
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  The US healthcare system.
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  And so kind of understanding those
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  macro industry dynamics is one thing.
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  But, you know, to your question, like, the
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  personal side gave me the kick I needed
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  to sort of make my vision a reality.
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  And, you know, that vision ultimately was to
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  bring together the best at payor contracting,
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  and to resource those individuals so effectively in
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  terms of data,
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  training, analytics, like human resources also so that
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  that they could both be more effective at
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  what they do,
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  and also at a scale that would allow
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  us to serve clients beyond just large health
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  systems that have a bunch of clout. So,
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  like, a residential treatment center, like your local
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  PHP IOP.
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  The goal being for us to help the
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  green rise. You know? And and behavioral health,
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  if you pay the best providers more, they're
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  gonna, a, join your network, allowing more than
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  just the 1% access care, and then b,
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  proliferate,
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  like, filling the void that we currently face
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  in behavioral health.
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  Yeah. Definitely. And I can imagine imagine the
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  payer contracting,
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  like, important
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  across the board, but even more so, I
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  imagine, for for independent practices, really looking to
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  to improve their reimbursement, ensure fair compensation when
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  they're thinking about conversations with payers.
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  On the reimbursement side,
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  what are some of the key obstacles that
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  you're seeing providers face in negotiating
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  fair reimbursement rates, and how can they start
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  to overcome such a big challenge that we
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  really hear about so consistently?
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  Sure. Yeah. So, I mean, they change over
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  time.
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  So I'll break this into two parts,
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  in terms of the challenges that we see
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  for clients, you know, often in their early
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  years versus when they're more mature from a
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  revenue cycle perspective.
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  What I mean by that,
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  at least in terms of early stage, is,
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  like, a lot of behavioral health providers have
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  had a historical reliance on cash pay or
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  out of network reimbursements.
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  And
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  my feeling after just seeing this for a
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  while now is that that can just be
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  fool's gold.
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  Revenue that's all cash pay or out of
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  network is flightier.
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  You probably like the margin today, but the
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  risk that it will erode
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  is very real.
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  That could come from shifts in the patient
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  population,
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  from out of network benefit design changes, you
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  know, basically forcing more onto the patient
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  client, in this case.
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  Fewer barriers to entry
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  for competitors,
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  if you're in that cash paywall, or even
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  over time, you know, you've got an aging
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  facility. So more competitors can come in, think
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  of deep kind of on those cosmetic
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  elements,
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  of trying to gain patients. And, you know,
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  if your organization's cost structure
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  gets bloated to match that out of network
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  revenue, it's really only a matter of time
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  until competition
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  begins to erode your census.
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  Not to mention payers just getting harder to
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  collect from on an out of network basis.
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  So that's really the one is that reliance
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  on, on cash pay and out of network
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  basis. So that's really the one is that
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  reliance on on cash pay and out of
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  network reimbursements.
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  And those risks, you know, those experiences as
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  those start to to happen to folks push
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  behavioral health providers to go in network. But
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  often,
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  you know, when they decide to go in
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  network,
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  the rates that are offered just aren't sustainable.
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  And that's another big hurdle.
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  It's especially frustrating because in certain markets,
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  there are just unquestionable
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  needs from a network adequacy perspective.
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  I mean, sometimes for clients, we'll get on
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  the phone and make calls to everybody who
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  says they are in the payer's network, and
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  no one's able to take somebody.
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  And so when you get these, you know,
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  bad rate offers, it's like they don't want
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  you. And that kind of gets to the
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  heart of our mission as a company.
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  You know, it's especially important to have payers
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  and providers make a deal, especially in behavioral
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  health, because it lowers the financial barrier for
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  patients and their families.
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  And so by allowing families to use the
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  in network benefits that they've already paid for
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  through their premiums,
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  more individuals in crisis can access quality care
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  that's gonna then prevent EDR visits and worse
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  for the payer.
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  Yeah. Certainly eye opening to hear
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  just the the anecdote you shared there on
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  calling those providers who they do say that
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  they're in the networks, but they aren't able
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  to take care of you because of those
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  other barriers that that you had mentioned previously
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  of of not being able to
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  run on the rates that payers are offering
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  once they do actually become a network. So
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  so many challenges that really seem to compound
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  one another.
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  And and that's that's the other side of
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  our mission. So is access to care, and
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  I just kinda touched on all the all
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  the barriers that we try to get around
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  in fulfilling that. And, you know, the is
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  to preserve the value of the provider. And
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  that and that really brings us to what
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  you just said, which is renegotiations. Once you
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  are in network, you're still facing some hurdles.
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  These schedules can change. And even if they
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  don't, you know, labor costs have.
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  So beyond the
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  contracts, we help providers, we think of it
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  as climbing the reimbursement ladder, often going from,
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  you know, breakeven reimbursement rates when they joined.
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  And at that level, like, you know, a
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  blip in your business performance can cost a
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  community a key safety net.
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  So going from those rates, something more sustainable
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  that will allow them, you know, eventually to
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  open a new facility where there's need. Like
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  I said, we we try to help the
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  cream rise, so it's not just the loudest
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  voices in the room that are getting paid.
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  It's those that are creating more value.
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  Yeah. That's certainly an important aspect of this
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  of this too.
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  Kevin, when you think about data,
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  what role does it really play when
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  informing
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  a contract review process in addressing all the
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  challenges we had just mentioned Or when you're
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  thinking about, you know, that reimbursement
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  ladder,
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  what role is data playing in helping
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  providers
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  secure something that is more sustainable?
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  Yeah. So this is kind of another two
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  parter.
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  On one hand, you have
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  sort of the look internally for outcomes data.
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  So that that's on one hand. And on
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  the other hand, look externally at at what's
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  going on with the competition.
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  Outcomes data can be its own hurdle, kinda
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  getting back to the other question, because it's
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  not ubiquitous.
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  And this gets to just sort of the
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  broken market mechanism in health care.
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  The quick aside,
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  there's a good example of that. We did
• 10:12
  a of its kind study in the fertility
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  space where there's actually really good public outcomes
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  data that's widely accepted,
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  comparing UHC's
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  reimbursement rates for specific providers to the patient
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  outcomes for those same providers,
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  zero relationship.
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  I wish this wasn't just audio so I
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  could show you the graph, but,
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  it it's it was astounding.
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  And so and specialties without ubiquitous or widely
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  accepted outcomes data like behavioral health,
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  I don't have a lot of hope that
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  it's gonna be better
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  than even fertility where there are good where
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  there is good data. And this is a
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  problem and an opportunity. You know, if if
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  you can get the right audience at the
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  payer
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  and bring really good data about the outcomes
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  that your facility or group can create, you
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  can begin to tell a winning story.
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  And so that's that's one side, which is
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  is that outcomes data. And, you know, there
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  are vendors out there who specialize in this
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  and and also help compare to other your
• 11:08
  outcomes to other providers.
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  Of course, from the payer side, you kind
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  of got that too. Like,
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  they're only seeing the folks that have good
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  outcomes because the ones that have bad outcomes
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  wouldn't tell them about it. So that can
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  it can be tough. But, again, if a
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  story can hang together,
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  it makes a big difference. So that's one
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  side of
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  it. And then, you know, the other side
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  is is market data. What are your competitors
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  getting paid? What services do they offer? And
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  how well are they doing it versus you?
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  And, you know, for the longest time, providers
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  had to rely on hearsay
• 11:39
  about their competitors' rates, which was far from
• 11:42
  comprehensive,
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  you know, putting them at a big information
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  disadvantage in their pair negotiations,
• 11:47
  in their strategy setting.
• 11:49
  And, you know, what's out there now because
• 11:51
  of the price transparency act, you know, it's
• 11:54
  public, but it's not
• 11:55
  usable without a subscription and some serious skills.
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  And so
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  that's one thing that we set out, you
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  know, three years ago to tackle.
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  And I mean, happy to talk a little
• 12:05
  bit more about kind of what that's made
• 12:07
  up of if you're curious.
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  Yeah, Kevin. Actually, I would love if you
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  could expand on that because it's one of
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  the things we hear a lot about when
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  we think about price transparency, being able to
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  put that data to use. Like, it's out
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  there. But to your point,
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  actually making use of it and having it
• 12:25
  show up in these conversations in a meaningful
• 12:27
  way is continues to be a pretty big
• 12:29
  challenge. So
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  how are you
• 12:32
  in Trebonus Health really tackling that?
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  This is another one where,
• 12:38
  the insight you know, it would really pop
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  if I could show you something. Podcasts have
• 12:41
  limitations. So anyone listening, we'd love to do
• 12:43
  a demo. But, let me talk to you
• 12:45
  about the data a little bit, and I'll
• 12:46
  try to describe the the visuals.
• 12:48
  So
• 12:49
  price transparency for folks that aren't familiar,
• 12:53
  the payers
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  had to start hosting
• 12:57
  all of their rates with every in network
• 12:59
  provider publicly.
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  And the problem here is that
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  the size of the data
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  is just crazy.
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  If you can think about, you know, just
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  one rate with one provider,
• 13:13
  you know, they could have for one code,
• 13:15
  could have multiple potential, you know, places of
• 13:19
  service,
• 13:20
  multiple potential modifiers,
• 13:22
  you know, one group could have different rates
• 13:24
  for MDs versus mid levels.
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  The sort of the the variability goes on
• 13:30
  and on, which compounds the size of this.
• 13:32
  And so that's sort of the fundamental problem.
• 13:34
  Our goal and what we successfully did with
• 13:36
  our tool
• 13:37
  is create something that allows you to fairly
• 13:40
  quickly
• 13:41
  control for all those different factors
• 13:44
  so that you can see
• 13:46
  exactly, like,
• 13:47
  within a given market, I wanna see all
• 13:50
  the residential
• 13:52
  facilities,
• 13:53
  their rate for one night for the specific
• 13:56
  code, you know, within Tennessee, give me those
• 13:59
  17 facilities. And so, you know, what what
• 14:01
  we do is create a histogram where you've
• 14:04
  got rate bins. So this one's
• 14:06
  800 to $900, there are 10 facilities. 900
• 14:09
  to a thousand dollars, there are eight facilities,
• 14:11
  and so on. And so you can see
• 14:13
  exactly where you stand
• 14:16
  on the codes that really matter to you
• 14:18
  and your competitors
• 14:19
  in in the market
• 14:20
  and find your specific competitors that you think
• 14:23
  are look alikes. And so then you can
• 14:24
  go on a very data informed way to
• 14:26
  the payer and say, hey. I'm getting paid
• 14:28
  800 while this facility over here who we
• 14:31
  know does a worse job,
• 14:33
  because we take a lot of their patients
• 14:34
  who are bouncing back.
• 14:36
  Oh, they're getting 1,200.
• 14:38
  And,
• 14:39
  you know, before, you may have said, okay.
• 14:42
  I could only
• 14:44
  possibly expect a 10% increase in my wildest
• 14:46
  dreams.
• 14:47
  Well, now, like, you know that $1,200
• 14:50
  number is yeah. It's a 50% increase, but
• 14:53
  it's something that's being paid right now in
• 14:55
  the market. And so it it adjusts your
• 14:57
  strategy, it adjusts how you'll respond.
• 14:59
  But, you know, you sort of need access.
• 15:01
  You need someone who's who's used to building
• 15:03
  those those, visualizations in order to to be
• 15:06
  able to deploy it.
• 15:08
  Yeah. Kevin, thanks for sharing that. I think
• 15:11
  it's helpful to hear just I think sometimes
• 15:13
  these conversations can can sound,
• 15:16
  you know, inadvertently simplistic when you think about,
• 15:19
  oh, it's just about pulling the data and
• 15:21
  comparing
• 15:22
  what this payer gets for this service. And,
• 15:24
  really, it's much deeper than that and being
• 15:26
  able to, to your point, have the the
• 15:28
  know how and the technological, like, expertise to
• 15:31
  be able to
• 15:33
  pull that data out, create tools that actually
• 15:35
  enable providers to do that in a meaningful
• 15:38
  way.
• 15:39
  Yeah. And that that's our vision in creating
• 15:42
  that tool
• 15:43
  was
• 15:44
  here we were, a company that always negotiated
• 15:47
  on behalf
• 15:48
  of our clients with the payers.
• 15:51
  But a lot of times, you do have
• 15:52
  folks that, you know, are never gonna wanna
• 15:54
  outsource that function.
• 15:56
  Well, they really need this data to do
• 15:58
  this well themselves.
• 15:59
  And so now we can give them a
• 16:00
  way to do that, whether it's us running
• 16:02
  a report and sort of furnishing them with
• 16:04
  the results
• 16:05
  or just giving them a subscription to the
• 16:07
  tool. And, you know, either either can happen
• 16:10
  or we can, you know, do both and
• 16:12
  negotiate for you. Right?
• 16:14
  It it just depends where sort of what
• 16:17
  a provider is coming to the table with.
• 16:20
  We can sort of plug in to fit
• 16:21
  and and get them prepared for that negotiation.
• 16:25
  Yeah. Thanks, Kevin.
• 16:26
  Well, earlier in the conversation,
• 16:28
  you know, we touched on your your deep
• 16:30
  connection to this space. And I know you
• 16:32
  had mentioned a bit about how when you
• 16:34
  started doing some market research, saw that a
• 16:37
  lot of the the payer contracting services, particularly
• 16:39
  in behavioral health, was a bit more more
• 16:41
  one off.
• 16:42
  So why is it important for behavioral health
• 16:45
  providers to partner with experts who do have
• 16:48
  more focus and specialized in a particular realm?
• 16:51
  What are some of the short long term
• 16:52
  benefits of that kind of relationship?
• 16:56
  Sure. I think the easy answer here is
• 16:58
  that you're leaving money on the table.
• 17:00
  If you hire a contracting vendor and they
• 17:03
  staff someone who thinks that the mat you
• 17:05
  keep talking about is just a really great
• 17:07
  clinician,
• 17:08
  you're not in the right place.
• 17:10
  And so you can have it all. Behavioral
• 17:13
  expertise
• 17:14
  and analytically rigorous negotiators,
• 17:17
  and a great client experience.
• 17:19
  Whatever you're leaving on the table dollar wise
• 17:21
  is just too valuable, so don't settle.
• 17:25
  Yeah. Thanks, Kevin.
• 17:27
  Before we wrap up, is there anything on
• 17:29
  the topic that we haven't gotten to that
• 17:31
  you think is really important to mention or
• 17:34
  leave listeners
• 17:35
  with?
• 17:36
  Yeah. So,
• 17:38
  look, a lot of folks, I think, if
• 17:39
  if they're considering doing this themselves
• 17:42
  or not, if they wanna outsource it, probably
• 17:44
  just wanna cut to the chase and another
• 17:46
  price, like how do we pay for someone
• 17:48
  like us? And something unique in our space
• 17:51
  is that we're able to meet providers where
• 17:52
  they are.
• 17:53
  I talked a little bit about how our
• 17:55
  personnel model can makes that possible. And, you
• 17:58
  know, some are looking to align Trebnis' fees
• 18:00
  with the outcome we create.
• 18:01
  And we can do that. And we'll offer
• 18:03
  a guarantee, you know, that a certain level
• 18:05
  of success will happen.
• 18:06
  Then again, some are more comfortable paying, you
• 18:08
  know, a larger fixed fee. That's still a
• 18:10
  generous discount versus what you'd have to pay
• 18:13
  to hire resources like us internally.
• 18:15
  So, you know, give us a call, and
• 18:17
  we can we can help evaluate if it's
• 18:18
  a fit. You can obviously find find us
• 18:20
  on on our website and, you know, reach
• 18:22
  out to our team directly.
• 18:25
  Well, Kevin, thank you so much for being
• 18:27
  on today. We we appreciate your time and
• 18:29
  insights.
• 18:30
  Thank you. Yeah. No. It was it was
• 18:32
  fun to be here, fun to chat, and
• 18:33
  I was short and sweet. Happy to do
• 18:35
  it again.
• 18:36
  Yeah. Absolutely.
• 18:38
  And listeners, we also wanna thank our podcast
• 18:40
  sponsor, Tribunus Health, and you can tune in
• 18:43
  to additional episodes of the Becker's Healthcare podcast
• 18:46
  by visiting the podcast page on our website
• 18:49
  at beckershospitalreview.com.
• 18:51
  Thanks, everyone.