INTRODUCING: THE PAYER PAYMENT IMPACT STUDY
JLW Medical Management Consulting is conducting multi-state research examining whether payer reimbursement disruptions, contribute to financial instability among outpatient behavioral health organizations and, ultimately, reductions in workforce, treatment capacity, patient access, and continuity of care.​​
OUR HYPOTHESIS
​Payer reimbursement disruptions may create consequences extending beyond individual claims and provider organizations by contributing to financial instability, behavioral-health workforce disruption, reduced treatment capacity, and interruption of patient access and continuity of care.
WHY THIS RESEARCH MATTERS
PAYER PAYMENT DISRUPTIONS MAY EXTEND BEYOND REVENUE CYCLE OPERATIONS
When reimbursement for services already delivered is denied, underpaid, or significantly delayed, the financial consequences may affect an organization’s ability to maintain staffing, operations, and clinical capacity.
​
WORKFORCE DISRUPTION MAY REDUCE ACCESS TO CARE
Hiring freezes, reduced clinician hours, unfilled positions, layoffs, or turnover resulting from financial pressure can translate into fewer available appointments, longer wait times, and reduced treatment capacity.
​
​
​
THE SCALE AND RELATIONSHIP BETWEEN THESE EVENTS REQUIRE BETTER EVIDENCE
While individual practices report reimbursement challenges, this research seeks to systematically quantify the frequency, magnitude, duration, and downstream consequences of payer reimbursement disruption across behavioral health organizations.
​
​
​
FINANCIAL INSTABILITY CAN BECOME A HEALTHCARE DELIVERY ISSUE
Behavioral health practices rely on predictable reimbursement to meet payroll, retain clinicians, maintain programs, and continue accepting patients. Prolonged payment disruptions may place those functions at risk.
​
​
PATIENTS MAY EXPERIENCE THE CONSEQUENCES OF PAYMENT DISPUTES THEY NEVER SEE
When practices reduce services, close panels, leave payer networks, or discontinue programs, patients may experience treatment interruptions, provider changes, delayed access, or difficulty locating alternative care.
​
​
PUBLIC HEALTH POLICY REQUIRES EVIDENCE THAT CONNECTS PAYMENT TO HEALTHCARE CAPACITY
By examining the relationship between payer reimbursement, organizational stability, workforce capacity, and patient access, this study seeks to determine whether payer reimbursement disruption warrants consideration as a broader public health issue, and what interventions, if any, the evidence supports.
​
​
​
THE EVIDENCE GAP
Claims data show whether behavioral health claims were paid, denied, delayed, or underpaid, but not what happens to practices and patients afterward. The Payer Payment Impact Study addresses this evidence gap by examining how significant reimbursement disruptions may affect practice financial stability, workforce capacity, healthcare delivery, patient access, and continuity of care.​​ The study does not assume that reimbursement disruption causes these outcomes. It is designed to measure the relationships, identify patterns, examine alternative explanations, and determine what the evidence supports.
PARTICIPATION CRITERIA
To participate in the Payer Payment Impact Study, you must:
-
Be a licensed clinician who owns or operates an outpatient behavioral health group practice, or who works within one.
-
Have direct knowledge of reimbursement challenges affecting either your organization or your personal finances.
-
Be able to provide information about current payment issues and/or experiences occurring within the past five years.
-
Be a RCM Specialist/Senior Leader/Executive Leader with working knowledge of the financial challenges the practice is having.
The study will examine both ongoing reimbursement challenges and historical experiences during a lookback period of up to five years.
