The health insurance giant Cigna (NYSE:CI) has long expressed interest in remote behavioral health care delivery.

It’s first big commitment came back in 2017, when the insurer rolled out its virtual care network, creating a system of thousands of behavioral providers able to deliver care remotely. In the years that followed, Cigna slowly continued to build out its virtual behavioral health coverage from there.

That is, until March 2020, when the coronavirus sped things up.

COVID-19 has accelerated Cigna’s long-term virtual behavioral health strategy, prompting the insurer to expand virtual behavioral health coverage, partner with new digital providers and add no-cost virtual behavioral services to its 2021 Medicare Advantage (MA) plans, among other changes. Post-pandemic, many of those additions will remain permanent, according to Eva Borden, managing director for Behavioral Health at Cigna.

“The [changes] that will be long-lasting are the pieces that really focus on enabling access to care quickly,” Borden told Behavioral Health Business. “The ability to have access to virtual care will not change. We will continue to have that and accelerate it.”

Overall, the long-term goal is to keep improving beneficiaries’ access to behavioral health care. That means continuing to add new behavioral health care delivery options to supplement existing ones, Borden said.

“When I think about the future of virtual care at Cigna, it will be a very multi-faceted approach,” she said. “It’s access to virtual care and video. It’s access to being able to engage digitally, whether on an app or text therapy or other forms. I anticipate that we will continue to advance in these spaces.”

Cigna’s past seven months have been frequently marked by such advancement.

The payer expanded tele-behavioral coverage, eliminated cost-sharing for all behavioral health visits and implemented a fast-access network to make sure behavioral patients get appointments within five days of requesting one. Plus, it expanded its centers of excellence for behavioral health programs.

On top of that, it invested in Ginger, a virtual behavioral health care system that partners with employers, health plans and strategic partners to deliver services via text and video. Additionally, it added a number of new virtual behavioral partners.

In May, the insurer struck a deal with Talkspace, giving the 14 million members enrolled in Cigna’s employer-sponsored plans the ability to talk and text with licensed therapists. It also formed relationships with Meru Health, MAP Health Management and NOCD to give customers virtual access to resources for anxiety, depression and substance use disorders (SUD).

“This is not to replace the providers in our network already,” Borden said. “It’s to enable … better access to them. … We already know that only a fraction of the people who have behavioral health needs [get] care. So … how can we open up as much access and availability as possible so that everyone who has need can get access to care quickly?”

Value-based agreement opportunities

In addition to improving beneficiaries’ access to care, the expansion of telehealth is also making it easier for insurance companies to measure behavioral health outcomes. Some stakeholders anticipate that, in turn, could create more value-based care opportunities for behavioral health providers.

When asked if Cigna was interested in expanding the number of value-based agreements it has in the behavioral space, Borden said “absolutely.” However, the payer won’t partner with just anyone.

In the end, it comes down to the relationship, Borden said. Specifically, Cigna is interested in value-based partnerships with providers who are willing to accept some risk, comply with reporting requirements and evaluate quality measures candidly. Additionally, they’re looking for “the ability to share information effectively and a level of trust that we’re there to drive affordability and quality,” Borden said.

Borden declined to disclose how many behavioral health providers Cigna is working with in a value-based capacity, saying that the agreements are more about quality than quantity.

Medicare Advantage additions and more

It’s not just Cigna’s traditional commercial beneficiaries who will have improved access to behavioral health services going forward. It’s also MA members, as well as employers and health plans who use the insurer’s relatively new digital health formulary.

For example, Cigna recently announced that it would offer no-cost telebehavioral services to the senior members covered by its 2021 MA plans.

Amid the pandemic, older adults are facing a number of new stressors, from the loneliness of social distancing to the fears that come with contracting the COVID-19 virus, which is especially deadly for seniors.

All those factors contributed to Cigna’s decision, according to Aparna Abburi, president of Cigna’s MA business.

“This kind of service is important for everybody, but especially older adults,” Abburi told BHB in an email. “Older adults tend to have more chronic conditions than younger people and those conditions can often cause depression, which, when left unchecked, can worsen health outcomes. Many older adults have lost friends and loved ones.”

Additionally, earlier this month, Cigna’s health services segment Evernorth added a new digital addiction solution from Quit Genius to its digital health formulary, Evernorth Digital Health Formulary.

Launched last year, the formulary is modeled largely after Express Scripts’ medication formulary. Express Scripts, a home-delivery prescription benefit plan provider, is also owned by Cigna.

The formulary is meant to help employers and health plans find secure, effective, user-friendly digital health solutions best suited for their members. Those solutions, which are vetted by Express Scripts experts, target conditions that correlate with high costs and complex needs.

Evernorth contracts with each digital health solutions provider on the formulary so plans don’t have to, giving them immediate access to turnkey solutions, which are available to clients a la carte. 

The formulary saves plans between $100,000 and $120,000 per solution on administrative burden alone, Mark Bini, chief patient experience officer of Express Scripts, told BHB.

The formulary’s new Quit Genius solution is designed to help members with nicotine cessation in particular. But leaders may well continue to add new behavioral health offerings in the future. 

“We are very excited about this company,” Bini told BHB “They are proven in this market. There are others that we may consider down the road.”