Beacon Health Options is challenging some fundamental notions in its latest approach to value-based care in outpatient mental health.
Neil Leibowitz, chief medical officer for the Boston-based behavioral health managed care organization and clinical services provider, said this starts with proving which specific therapies improve care outcomes and lower care costs based on claims data. Beacon Health is part of major insurer Anthem Inc. (NYSE: ANTM).
It also calls for identifying new measures and better ways to gather and measure data.
“We can bump [good care] against claims and cost … and figure out does good care actually drive good outcomes,” Leibowitz said during a fireside chat during Behavioral Health Business’ event VALUE. “That becomes a primary measure. It’s actually better than a blood test in a way.”
Beacon Health Options has not yet settled on which outcomes or measures its latest iteration of value-based care will focus on, Leibowitz said. But he did express skepticism about common measures being used in value-based care today.
Many models, including Beacon Health Options’ previous iteration of value-based care, try to retrofit process measures such as seven-day follow-ups after a hospital visit, and incorrectly called them outcomes measures, Leibowitz said.
He also says that standardized screening assessments — such as the GAD-7 for anxiety and the PHQ-9 — don’t present actual outcomes and have limited utility in the context of value-based care.
“The theory is if you’re delivering good care the outcomes will follow,” Leibowitz said. “Yet all we’ve done is taken proxies for the outcomes.”
Leibowitz pitched AI-enabled analysis and transcription of therapists’ sessions as a way to help analyze therapy sessions. He notes that his previous employer Talkspace used this tactic to evaluate a therapist’s empathy, intervention types and the therapist’s understanding of motivational interviewing, for example.
“If we go back to the evidence, what we do know about behavioral health and we know that works — I want to know about empathy; empathy is the main driver,” Leibowitz said of a measure that he knows Beacon Health Options will look at in terms of assessing value-based care.
Patient-specific data would be blinded and would be assessed in the aggregate at the provider level when developing potential, new measures for care provided by therapists.
Another key potential measure for the company, according to Leibowitz, will be clinician skill sets and specific therapist interventions. He wasn’t sure which will take a primary focus: “What I want to know is which ones actually drive outcomes and cost of care.”
A look at where Beacon Health Options is heading with measures
Insights on both empathy and therapist skill sets in the Beacon Health Option value-based care model 2.0 for mental health would be derived from automated voice transcription and analysis, Leibowitz said.
The technology required to do voice analysis and pair it to outcomes at scale already exists today.
Potential hurdles to the practice could be patient consent to have sessions recorded and analyzed and resistance from clinicians. Leibowitz said patients would have the option to opt out but speculated that most won’t have an issue with it. He also said that mental health clinician education infuses skill coaching and seeking better ways to provide care.
He also said that if any of the largest outpatient mental health providers — such as Lifestance Health Group Inc. (Nasdaq: LFST) or Refresh Mental Health — adopt voice-based technologies that large swaths of the provider population would be using it anyway.
Voice-based technologies also have potential as practice management or business intelligence tools to objectively assess if and how well therapists are complying with evidence-based practices.
It won’t take Beacon Health Options “years” to glean insights on what outcomes the company will track in its new approach to outpatient mental health value-based care.
When paired with claims data, which Beacon or Anthem has, Beacon should be able to glean insights even with relatively smaller sample sizes.
“It’s really taking the data from these visits and trying to understand what are really the drivers,” Leibowitz said. “It seems like someone who’s good at motivational interviewing will have better outcomes. … I’m not sure anyone can tell me that that person has better outcomes with lower cost of care. It’s intuitive, but it doesn’t mean it’s true.”
In a follow-up email, Leibowitz said Beacon and Anthem are presently planning a pilot that will go-live in the last three months of the year.
“Given that this is a completely new way of looking at clinical care from a managed care angle, we want to make sure we roll this out in a thoughtful way and ensure that we are measuring what matters,” the email states.
Editor’s Note: This story was updated to reflect that patient-specific data would be blinded in these proposed practices.