Part 2: Provider-payer partnerships in crisis services

Last newsletter, we broke down the concept of provider-payer partnerships, discussing their function and illustrating their potential with an example from the Arizona crisis system. This week, we delve into the reasons these collaborations are crucial and shed light on the operational enhancements for quality improvement made in Pima County, Arizona, stemming from the partnership. This information is based on insights from the academic work "Provider-Payer Partnerships as an Engine for Continuous Quality Improvement" – co-authored by Connections Chief Clinical Innovation and Quality Officer, Dr. Margie Balfour.

Arizona’s success story

The provider-payer partnership between the Southern Arizona Regional Behavioral Health Authority (RHBA) and Connections Tucson Crisis Response Center benefited both individuals in crisis and the broader crisis system. The partnership’s outcomes included:

• Lower readmission rates: A comparison of data from 2016 and 2017 indicated a significant reduction in readmission rates to observation and inpatient units.
• Enhanced services for youth: The RBHA developed an in-home wrap-around services program, aimed at ensuring the stability of youth exiting crisis situations.
• Alternative crisis interventions: Crisis Mobile Teams started responding to school calls instead of law enforcement, providing a less restrictive response to youth crises.
• Improved outpatient care coordination: Outpatient behavioral health providers initiated rounds on their admitted patients at the Crisis Response Center, enhancing post-crisis coordination and reducing youth readmissions.
• Better multi-agency coordination for adult crisis service users: High-frequency users were identified and reported to the RBHA, who facilitated inter-agency discussions to improve care coordination, fulfilling the complex needs of these individuals and reducing readmission rates.

Lessons learned from Arizona’s provider-payer partnership

This study, along with the case of Pima County's partnership, spotlights the enormous potential that provider-payer partnerships hold for advancing both individual and system-wide quality improvement efforts and enhancing outcomes across the care continuum.

Key lessons for organizations to consider:

• Engaging relevant decision-makers in the Provider-Payer Partnership who can access required information and institute changes for Quality Improvement (QI) is vital.
• Quality improvement initiatives should be data-driven, swift, and iterative. Multiple methods can be tested concurrently to address an issue, with regular reevaluations necessary to enact significant change.
• Each provider-payer partnership will be unique, reflecting the participants, the region, and the specific needs of those utilizing crisis services.

There is no size fits all in crisis but Provider-Payer Partnerships as an Engine for Continuous Quality Improvement highlights the many advantages that Provider-Payer Partnerships can bring to a crisis continuum when focused on collaboration, data-driven decision-making, and working toward common goals of improving system care and outcomes for individuals in the community.