Clinician Responsibility in Value-Based Payment Systems

The Controversies in Psychiatric Services column aims to highlight differing viewpoints on topics relevant to psychiatric services that have generated a debate or a divide in opinion. In our inaugural edition of the column, the editorial team chose to focus on the issue of value-based payment, asking authors to respond to the following statement:

A value-based system of payment for psychiatric services that places financial responsibility for behavioral health outcomes on the treating clinician is the best way to promote better outcomes and reduce unplanned care.

We believe this topic is timely; it has long been recognized that the U.S. health care system far outpaces comparable nations in health care expenditures yet lags in terms of quality indicators. National trends suggest that “value-based” payment arrangements are here to stay, and as these models become more common, the impact on how care is delivered—and what our identities as clinicians are—will change dramatically. Bhalla and colleagues articulate a robust argument in support of value-based payment for psychiatric services, whereas Dr. Buck reminds us of the important limitations to consider in incorporating value-based payment into behavioral health. With our current understanding, can we define which metrics matter most to ensure the best outcomes? Are psychiatrists ready for the culture change that value-based care will usher in? These two perspectives offer insights into the complexities of this important service delivery issue.