Behavioral health should shift to value-based care despite challenges, Evernorth says

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Basing payment on clinical outcomes rather than the volume of service is increasingly common among medical practitioners, yet value-based reimbursement is less common among mental health practices. According to a new paper published by Evernorth, a Cigna subsidiary, value-based care in mental healthcare should be more common, and providers should be making the switch.

The transition is necessary, Cigna experts said, because value-based care reimbursements incentivize better care, largely by rewarding outcomes such as reduced wait times, reduced emergency room utilisation and improved patient quality of life.

“The psychiatric profession has experienced several paradigm-shifting breakthroughs in recent decades,” said study co-author Dr. Stuart Lustig, national medical executive for behavioral health strategy and product design, The Cigna Group. “We believe the next frontier in behavioral health is value-based reimbursement, which aligns reimbursement with presumably better care of individuals and populations at a time of increasing scrutiny on cost, quality, and outcomes.”

WHAT’S THE IMPACT

That’s not to say there aren’t challenges. Value-based care relies highly on data, and only 20% of mental health practices use measurements in their practices, the paper found.

A technology gap is another issue: Experts cited a study showing mental health providers are slower than hospitals to adopt electronic health record systems.

Another challenge is the shortage of mental health practitioners in payer networks. Unlike physicians in other specialties, many psychiatrists operate cash-only practices. Just 55.3% of psychiatrists accept private fee-for-service insurance, one study found, compared with 88.7% of those who practice in other areas of medicine.

Payers have been hesitant to drive value-based reimbursement due to the need to maintain robust networks for their members amidst nationwide shortages of psychiatrists, Cigna experts said.

Still, experts said stakeholder support for value-based mental healthcare is increasing, and measure-based practices are gaining endorsement from key organizations and policy advocates. Overall, consensus is growing.

“Ultimately, we believe that an increasing number of practices and facilities will have an increasing number of patients in value-based reimbursement arrangements, dependent upon candid conversations about how incentives will be paid,” the authors wrote, adding that the willingness of providers to work with payers leaves them optimistic about the future of value-based reimbursement in behavioral healthcare.

THE LARGER TREND

Evernorth launched a measurement-based care program for its behavioral health network in 2023. The goal is to better align payers and providers when it comes to measuring the success of medical treatments – which in turn would drive better care and lower healthcare costs, Evernorth said. 

And since providers often use a number of different measures across multiple payers, the organization expects the move will also ease administrative burden.

Data published by Evernorth later that year showed the prevalence of behavioral health conditions grew by 4% from 2021 to 2022. The analysis, which looks at anonymized and aggregated claims data of six million people from 2021 to 2022, found that increases in prevalence vary by condition, with the largest occurring within attention-deficit hyperactive disorder (ADHD), personality disorder and autism spectrum disorder.

The data also shows that the 22% of patients with a diagnosed behavioral condition drive 41% of total healthcare spend for the entire population.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.