Date of Award
Spring 5-22-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Joseph Burkard, DNSc, CRNA, EBP-C, AACN Health Policy Fellow
Abstract
Purpose: This project examines the impact of the fee-for-service (FFS) reimbursement models on provider burnout within Assertive Community Treatment (ACT) programs and proposes a hybrid reimbursement framework that integrates case-rate and outcome-based payment structures. The goal is to enhance care quality, improve provider retention and optimize patient outcomes by addressing financial and administrative inefficiencies inherent in the current model.
Background: Mental illness affects over 59 million U.S. adults with serious mental illness (SMI) presenting significant challenges in healthcare delivery. ACT is an evidence-based, multidisciplinary approach designed to provide intensive, community-based psychiatric care to individuals with serious mental illness (SMI). However, the FFS reimbursement model prioritizes service volume over patient-centered, outcomes-driven care, contributing to excessive administrative burdens, financial unpredictability, and clinician burnout. A hybrid payment model—incorporating per-member-per-month (PMPM) payments, bundled case rates and value-based incentives can enhance ACT program sustainability, improve fidelity to the ACT model and reduce workforce attrition.
Methods: A comprehensive literature review was conducted to evaluate the effects of FFS reimbursement on clinician burnout in ACT programs. Alternative payment models, including case-rate, PMPM, and value-based structures were analyzed for their potential to improve financial sustainability while reducing administrative burden. Data from high-fidelity ACT programs, policy reports and reimbursement models from other healthcare settings were synthesized to develop a proposed hybrid payment framework.
Results: Findings indicate that the FFS reimbursement model exacerbates provider burnout, contributes to workforce instability and threatens ACT model fidelity. In contrast, alternative payment models that emphasize care coordination, financial stability and outcome-driven incentives have been associated with improved provider satisfaction, reduced turnover and enhanced patient outcomes. A hybrid reimbursement structure integrating PMPM payments, bundled case rates, and performance-based incentives offers a viable and sustainable funding mechanism for ACT programs, ensuring financial viability while preserving the integrity of service delivery.
Evaluation: Shifting ACT reimbursement from a FFS model to a hybrid structure has the potential to reduce provider burnout, enhance program sustainability and improve patient outcomes. Policy recommendations include advocating for Medicaid and state-level funding modifications to support the implementation of alternative payment models. Further research and pilot programs are necessary to evaluate the long-term impact of these reimbursement changes on service delivery, provider well-being and clinical outcomes.
Keywords: Assertive Community Treatment, fee-for-service, alternative payment models, value-based care, per-member-per-month, case rate, bundled payments, clinician burnout, serious mental illness, mental health policy, provider reimbursement
Digital USD Citation
Thompson, Amanda M., "From Fee for Service to Outcome Based Care: A Policy Proposal to Reduce Provider Burnout in Assertive Community Treatment" (2025). Doctor of Nursing Practice Final Manuscripts. 315.
https://digital.sandiego.edu/dnp/315
Copyright
Copyright held by the author
Included in
Community Health Commons, Psychiatric and Mental Health Commons, Psychiatric and Mental Health Nursing Commons
