Payers Overwhelmed by Overflow of Behavioral Health Point Solutions

Mental health providers are increasingly innovating among specific patient populations as part of their value-based care strategies, a trend that’s turning into a challenge for insurers and employers.

One of the pain points is the focus on only a subset of individuals, when employers and insurers are looking more broadly at their entire population.

Payers have members with a spectrum of behavioral health needs, including severe mental health conditions, substance use disorders and developmental disabilities, according to Dr. Katherine Knutson, senior vice president at UnitedHealth Group Inc. (NYSE: UNH) and CEO of Optum Behavioral Care. Knutson’s organization prioritizes “comprehensive” solutions, but likewise works with “very focused providers,” she explained.

“Our challenge is taking that very focused provider, and then bringing it and making it part of a whole continuum,” Knutson said. “That is a challenge we haven’t completely solved, but that we are working very closely on.”

Additionally, figuring out the right point solution to partner with can be hard. With so many flooding the mental health market, it’s a challenge just sorting through them.

“Employers are getting pinged a lot by these focused solutions,” Knutson said. “They don’t have the same understanding of the behavioral health system and the population, as we all do. And so it’s hard for them to sort through. … Employers also need this more comprehensive approach to managing their population.”

Learning to work together

Along with challenges working with hyper-targeted providers, there can be a culture shock between payers and digital mental health providers, which raised over $5 billion in 2021. Today’s digital mental health providers typically like to move quickly during implementation, while their payer partners can be more methodical in their approach.

Generally, payers have checks and balances they are required to do to protect their members and themselves, especially when they enter into value-based care arrangements, Cara McNulty, president of the behavioral health and employee assistance program at Aetna, said at VALUE. Aetna is the health insurance arm of CVS Health Inc. (NYSE: CVS).

“We have work to do, to increase how quickly we can move,” McNulty said. “I’m holding us accountable to … moving faster, helping to set up the construct so that early startup company or that provider who wants to really engage in value-based care has all the ingredients they need to show us so that we can work together.”

However, payer and startup enthusiasm could lead to potential pitfalls and misunderstandings between the pairs.

“I’ve seen it over and over,” McNulty said. “It’s an early startup company, they have a really solid model, they don’t have a lot of people in their provider service, and then we get involved and we’re like, ‘Well, can you do this? Can you do this?’ And pretty soon, that business, what it started as, now is [doing] everything. And the mission is different.”

In these cases, the payer may get excited about the new possibilities. But if added capabilities means that the provider can’t deliver outcomes or the company goes under, that’s the worst possible scenario, said McNulty.

To avoid such speedbumps, providers should be upfront with the payers, telling them what is and isn’t feasible.

Working with early-stage providers is a two-way street, as both parties need to be flexible in their approach.

“I also want to make sure that we are getting the feedback from our partners and we are working collectively because otherwise, … we will never get to that place that is driving better outcomes,” McNulty said.

Aetna has a history of working with point solutions. For example, in March the company announced a partnership with eating disorder treatment provider Equip to provide virtual treatment services to the insurer’s commercial members.

At the time of the deal Aetna said it was interested in pursuing the partnership because of Equip’s’ evidence-based approach to care.

Outcomes data can help ease the process

Outcomes are a top priority for payers. At VALUE, panelists stressed the importance of all companies, but especially new startups, being able to show outcomes backed by concrete data.

“Early companies, [if] you can invest early on in an evaluation with a valid control group to where I can look at your data and really, really be able to demonstrate that it was your intervention that made that difference in all the cost outcomes, that will make things go much, much faster as we are working with our actuaries and finance people,” Knutson said.

Value-based care focused addiction and mental health care provider Eleanor, which recently raised $50 million in venture dollars, is able to show payers concrete data.

“When we go to payers and talk to them about a population-based approach, we come with the data that we have achieved in our care model,” Corbin Petro, CEO and co-founder of Eleanor Health, said on the panel.

“We come with quality outcomes, access outcomes, satisfaction outcomes and cost outcomes. So our ability to reduce the total cost of care, our ability to improve quality and retain folks in care is what’s led us to have great … value-based partnerships with payers.”

Petro noted that at Eleanor, the team built the model with a clinical, evidence-based approach. The company has incorporated claims data since its inception.

“Having an Elenor or others coming to say, ‘This is what we’re doing, here’s how we’re measuring, here is what course correction looks like when we aren’t getting that outcome or engagement, and here is how we are defining quality,’ is [important],” McNulty said.