Innovations in accessing care

Blue Cross and Blue Shield of North Carolina’s (BCBSNC) recent announcement about its new value-based care payment model, “Blue Premier Behavioral Health” highlights the industry’s continued quest to find innovative ways to address mental healthcare as part of comprehensive individual well-being.

Providers, health plans and patients alike have been caught up in a system that has not kept pace with the more “traditional” side of the business, i.e., medical and physical care, in terms of access, quality and reimbursement and whose problems have been exacerbated by a drug use disorder epidemic.

Since the advent of value-based care, the need to integrate behavioral health into primary care models became apparent as opportunities in quality and cost were identified through information and intelligence not previously available to providers. Glaring out of network utilization and costs were fueled by lack of access to participating behavioral health providers coupled with patients self-referring to non-participating providers.

Insured patients with behavioral health conditions result in higher cost sharing amounts when compared to insured patients with certain common chronic physical diseases[1]. The untold numbers of patients who do not seek treatment at all, as well as the impact of mental health on physical health, adds further complexity.

BCBSNC’s partnership with Quartet, a New York City startup seeks “to measure the quality of care patients receive and create incentives to providers for improved access to in-network care, collaboration among providers, and improved patient health outcomes…” A physician-led company, with mental health advocate Patrick Kennedy on its board, Quartet will use its central technology platform and services to drive accessible, personalized and collaborative care. And it has attracted a number of other believers, including Highmark (PA) Cambia Health Solutions (OR) and Horizon Blue Cross Blue Shield (NJ), who have entered into partnerships with the company, as well as some Medicaid Plans (IlliniCare Health, Louisiana Healthcare Connections).

Capital investors, including Centene have continued to demonstrate their confidence in Quartet. Consistent with other large national health plans, Anthem, on the other hand, has chosen a different path, bringing behavioral health services under its own corporate umbrella, with its pending acquisition of Beacon Health Options, the largest independently held behavioral health organization in the country. Citing addressing the needs of the whole person, two likely other considerations are the need to scale broadly and quickly due to membership throughout the country, coupled with their strategy to diversify across all dimensions of health care both in delivery and business.

A look ahead

Many questions remain unanswered.

How will quality and treatment outcomes be measured in behavioral health?
While physical health has discreet and often evidenced-based metrics associated with it (e.g., a blood pressure reading, BMI or a lab test), outcomes for successful treatment in behavioral health are more difficult to quantify. Contributing factors can be subjectivity on the part of patient and health care provider as well as a behavioral health issue manifesting itself or contributing to a physical complaint or condition.

How will providers be incentivized to see that patients are screened properly and effectively for mental health issues?

The good news is that integration of behavioral health into the primary care setting has begun and screening tools, especially for depression, have been available and in many practices, used effectively. Even hiring and/or collocating behavioral health professionals at the point of primary care has been a strategy deployed, taking the burden off the primary care provider, which can lead to quick identification of a behavioral health issue and the institution of an appropriate plan of care. Primary care providers and health plans will need to continue to work together on the recognition of integration from both a quality and financial perspective.

On the cost side, will technology resolve access and adequacy problems?

It is unclear how technology will resolve the lack of behavior health professionals’ participation or just lack of available practitioners. Using data and input from all stakeholders, including patients can hopefully foster creative solutions.

Finally, are health plans willing to adjust benefit designs to meet the specific demands in mental healthcare?

While parity in medical and mental health benefits was supposedly achieved, cost barriers, primarily in the form of high deductible plans and the nature of behavioral health treatments, can add additional strain to an already fragile patient seeking care. Since the lack of behavioral healthcare can negatively impact physical health, as well as fuel unnecessary treatments and costs for patients, health plans and employers, tailoring mental health benefits to meet the needs of patients while addressing health plans’ desire to address quality and cost should be examined further.

Conclusion

Maybe Quartet and others have these answers. It is difficult to say due to the proprietary nature of the offerings.  Hopefully, this activity is a sign of good things to come for patients, providers and plans in the quest for the best possible behavioral healthcare.

As a leading change facilitator in this era of sweeping health care reform, the Mazars Healthcare Consulting Practice offers healthcare payors and providers a powerful combination of service and results-oriented strategy to help them meet their business goals, overcome challenges, and improve performance. For more information about their timely, valuable information and insights into policies, best practices and industry developments, visit mazars.us/hc.

[1] JAMA Network Open. 2019;2(11):e1914554. doi:10.1001/jamanetworkopen.2019.14554 Reprinted

Published on February 24, 2020

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