Standardized credentialing, cost-reimbursement transparency can accelerate peer-to-peer use in behavioral health care.


After years of national behavioral health workforce shortages, many provider organizations are now looking to use peer specialists.

Advocates argue that peers can be a critical component in expanding access to behavioral health and fully supporting patients in recovery. However, payment challenges and various state licensing requirements have historically hindered providers using the peer workforce.

However, this may change soon as the federal government seeks to address some of these issues.

“Individuals with lived experience have a lot to bring to the table,” First CEO Sameer Malik told Behavioral Health Business. “There are 20,000, 30,000 people with life experience who want to help others who are struggling right now. And the emergence of a narrative around this is a good sign that we recognize that – as a country, at the administrative level – these people have something very important to bring.

Firsthand is a New York-based company that uses a peer support model to help engage patients with severe mental illness (SMI). The company recently raised $28 million in a funding round led by Google Ventures.

Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of Rehabilitation and the US Department of Health and Human Services (HHS). New national model standards have been released Certificate in Peer Support with a focus on the Behavioral Health Worker.

While the new standards do not replace any state certification, their goal is to accelerate “universal acceptance, recognition and integration” of the peer mental health workforce across the country.

A SAMHSA spokeswoman told BHB in an email that “States recognize the value peer workforces can provide to behavioral health care and are looking for ways to support and grow these critical services.” It includes.”

Although the new guidelines are not regulatory requirements, SAMHSA will “explore a number of strategies to encourage adoption, alignment and convergence in our collaborative relationships with our various state partners,” according to a spokesperson.

Some see this guide as a way to help bring visibility to peer support discussions.

“Certifications not only define the role and services provided by peer specialists, but reinforce their importance in behavioral health care delivery,” Michelle Gurara, senior advisor for public health and health equity at RTI Health Advance, told BHB in an email. “The recent HHS and SAMHSA peer certification guidelines will elevate the discussion of the full spectrum of peer support services and may provide impetus for states to create advanced certification or specialty child/adolescent certification, which can fill workforce gaps in the child behavioral health space.

Historical tests

According to Malik, one of the biggest challenges to using peers is at the business level, not necessarily at the clinical or operational level.

“The structural challenge we have seen is at the system level. How do we pay for that… and what is the criteria? What is the proof? How do we know if this is true at the level of payment or not,” Malik said. “Many jurisdictions have adopted some standards and certifications as initial efforts to adopt some…best practices… . A certain level of training can make a real difference to people who are still struggling.

The US Centers for Medicare & Medicaid Services (CMS) has been at the forefront of peer-to-peer payment. About 15 years ago, Medicaid directed states to cover peer support services.

Despite the federal government’s move in this direction, business payers are still often late.

“Since 2007, Medicaid has allowed states to pay for peer support services and CMS considers peer support an evidence-based intervention,” Guerra said. “Most states do. Return money Peer support services, however, do not cover both substance use disorders and mental health. Out of programs Athena (CVS Health) and Signa, Many private health plans do not specifically pay for peer specialist services.

Providers engaged in value-based care contracting may be well positioned to include peer support services as part of their package of care. Using peers can help reduce the overall cost of care.

Guerrera indicated from a study The LancetPeer-delivered self-management has been shown to reduce recidivism rates among individuals leaving mental health crisis services.

“Adding peer specialists to engage clients during implementation planning and after transition into the community can help reduce readmissions,” Guerra said. “Health plans can be incentivized through financial rewards to demonstrate additional reductions and hit pre-set outcome goals.”

While providers operating on a value-based care model may have certain flexibility that makes it easier to use peers, that doesn’t mean they can’t use peers in a fee-for-service model. Malik explained that both ways could work.

“A fee-for-service willingness to recognize and compensate for the cost of peer intervention will bring more to the market,” Malik said. “It has the potential to put value-based care into practice. [the peer model] In very high impact areas, and not limited to specific guidelines how to define the only setting in which a state or payer will pay for peer services. But really, with a value-based contract, you have a few more degrees of freedom where it’s really beneficial.

Career ladder for peers

If providers can overcome the business challenges associated with peer-to-peer payment, it may be an opportunity to tap into a new behavioral health workforce.

Peers can have a unique role in the behavioral health worker by helping to navigate the patient’s holistic care needs to services that determine health issues such as housing and meals. Peers may be able to deliver more culturally informed care and supportive interventions than the traditional medical community, Guerra said.

“The peer specialist’s life experience is an additional element to build a different trust and understanding with clients, which clients cannot get with traditional providers,” she said.

Still, some caution that providers should invest in developing the peer workforce rather than resorting to paying less than clinical staff.

While the U.S. Bureau of Labor Statistics does not explicitly collect data on peer support specialists, they are counted among community health workers, averaging Under $60,000. Career search platform Glassdoor The average peer support specialist in the US is estimated to earn approximately $39,968.

Some behavioral health leaders have already raised this point as an issue.

“I have a problem [with providers] Use as cheap labor. Dr. Nazlim Hagman, senior vice president and co-chief medical officer at Commonwealth Care Alliance, discussed education at the HMA Healthcare Quality Conference in March. “We have a shortage of suppliers. How can we give opportunities and ways for peers to be more than peers? And don’t get me wrong, I’m not saying they aren’t enough. But again, are there ways to give permission? Are they ways to make it easier for them to get higher education?”

Commonwealth Care Alliance is a Boston-based nonprofit focused on integrated care. The system is projected to have $2.5 billion in revenue by 2023 and a workforce of more than 2,000.

Malik said that for the first time equity is a priority and all peers will receive the same benefits as the CEO. The company is focused on providing career development direction to its peers.

For example, on their own, peers start out as beginning instructors, but after a year, they can move up to senior elementary instructors. More experienced peer specialists are still working with clients in the community but help train the new workforce.

“We are still hearing. [clients]We’re still doing documentation, we’re still doing all those things,” Marie Hanna, a first-time guide, told BHB. “When it comes to senior first instruction, we’re helping other colleagues who are now being hired. It’s helping them get in with training and all that good stuff. And then letting them see what we do. We get them out into the community, they look at them, we look at them and then we move on.

While there are questions about the future of the peer workforce, many are still optimistic about what the future holds and welcome the national focus on the topic.

“I’m really optimistic about where we are at the policy level and also at the payment level,” Malik said. “Yes, there is work to be done. But now we are in a good place. I think one of the most important changes yet to come is for society to acknowledge the real impact that people living with or with severe mental illness can bring to the table, we still have to fight stigma.


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