Autism treatment provider Cortica Inc. has entered into a new value-based care payer arrangement that may accelerate the development of similar deals in the future.
Insurer Point32Health now has an outcome-focused value-based care agreement with San Diego-based Cortica for members enrolled in Point32Health Massachusetts’ Medicaid and commercial health plans.
“It’s these kinds of groundbreaking collaborations between health plans and providers that enable value-based care to be offered,” Dr. Suzanne Goh, co-founder and chief medical officer of Cortica, told Behavioral Health Business. “We and Point32Health are very committed to and passionate about this, because it is the mechanism for delivering better outcomes for children and families.”
Cortica seeks to emulate the all-in-one, coordinated clinical approach of academic medical centers. The company’s 15 centers offer all the medical and behavioral health services that a child with autism or other brain-related developmental differences needs short of primary care services.
These include Applied Behavioral Analysis (ABA), neurology, physical therapy and developmental pediatrics to name a few.
Point32Health is the outgrowth of a merger of health plan providers Tufts Health Plan and Harvard Pilgrim Health Care. Tufts’ commercial health plan members now have access to Cortica through the model. Harvard Pilgrim commercial plans temporarily only have access to the Cortica behavioral health services while the plan completes an in-sourcing of behavioral health benefits from United Behavioral Health.
Point32Health’s MassHealth, or Medicaid, members will have access to Cortica at some point in the fourth quarter. All other Point32Health members will be able to access all of Cortica’s services by July 1, 2023.
Prominent voices in the management of autism treatment companies have pointed to value-based care as both an inevitability and a necessity for the space.
Earlier in the year, Action Behavior Centers CEO Hersh Sanghavi told BHB that “value-based arrangements are the future.” Indianapolis-based Hopebridge Inc. rejigged its leadership team to prioritize care outcomes and value-based care.
“To date, there are very few known replicable and scalable value-based care arrangements in the autism treatment market,” Sara Litvak, CEO of the Behavioral Health Center of Excellence (BHCOE), an autism accrediting organization, told BHB in an email.
One major hurdle to the adoption of value-based care in the autism treatment space is the lack of consensus around what is worth measuring to assess value. Litvak highlighted a fractured conversation around measuring care quality, defining outcomes, and “whose voices are considered and how they are considered” in the process.
BHCOE partnered with payers such as Cigna Corp. (NYSE: CI) services division Evernorth to develop potential industry standards for care outcomes. It also has partnered with Centene Corp. (NYSE: CNC) Peach State Health Plan.
“Any model should be transparent and clear around the obligations for both payers and providers in regard to data reporting,” Litvak said. “Data aggregation can be a challenge for ABA providers, but value-based care provides the opportunity for the ABA therapy provider community to take a uniform approach to measuring patient outcomes and provider quality.”
What’s valuable? And how is it paid for?
The Cortica value-based care program with Point32Health is broken down into four tracks of increasing scope and intensity. It seeks to accelerate a child’s entry to care.
Point32Health expects members to receive a care plan assessment within 15 days on average of receiving an Autism diagnosis and then, in turn, to start treatment within 15 days of receiving a care plan assessment.
A study published in 2016 finds that wait times for ABA average about 3 and a half months, while a media report finds wait times can range from three months to a year.
Once in care, Cortica establishes a “whole-child scorecard” for the child’s development. Cortica remeasures the child’s development every six months based on standards recommended by the Behavioral Health Care Center of Excellence and The International Consortium for Health Outcomes Measurement, Goh said.
To date, there are very few known replicable and scalable value-based care arrangements in the autism treatment market.
Sara Litvak, CEO of the Behavioral Health Center of Excellence
Cortica also tracks process measures such as speed to care and Net Promoter scores.
Point32Health pays Cortica a monthly case rate depending on the track of the child. The care tracks and assessments for those tracks were developed in collaboration with Point32Health, Goh said.
The arrangement also has a “pay for performance” element, Jill Borrelli, vice president of behavioral health at Point32Health, told BHB.
These include payment bonuses for achieving predefined goals in improving the care outcomes of children and meeting specific process measures.
What this deal does for Cortica and for Point32Health
Founded in 2014, Cortica has been building a practice in anticipation of the payer market recognizing the benefit of value-based care and shifting to it. The company so far has operated under fee-for-service contracts that don’t account for the costs of non-clinical services such as care coordination, Cortica co-founder and CEO Neil Hattangadi said in a previous interview.
“So much of what we built in the Cortica model was working toward this,” Goh said. “[It] allows us a much greater ability to hone in and focus on quality. … For our clinicians to be able to think about the quality of care above all else — and that’s what we are measuring — that’s what matters to the payer and the family.”
A value-based care arrangement coupled with an all-in-one approach to care also simplifies the care journey for patients’ families who typically have to coordinate care for autism patients with several different specialties.
In that case, it’s not likely that treatment plans are aligned with each other, Borrelli said.
“The family is already dealing with a very stressful situation,” Borrelli said. Speaking of the care coordination services provided by Cortica, she added, “This is part of what makes the relationship with Cortica so special; It’s that all these types of services are in the same medical record, in the same case tracking and then managing being managed holistically.”
Point32Health upping the ante on outcomes
Cortica’s technology platform supports both the tracking of care and process outcomes and the coordination of care across Cortica specialties.
“The reason why this has been successful between Cortica and Point32 is because, first and foremost, our rigorous measurement and reporting of outcomes … and our clinical leadership succeeded in building programs [based on collaboration,]” Goh said.
Point32Health tracking care outcomes is a vital part of integrating medical and behavioral health care, Borrelli said.
“There’s so much research that says there’s an increased cost for someone dealing with a complex medical situation, no matter what it is, because of co-occurring mental health or substance use issues,” Borelli said. “It’s common sense that if you are treating the whole person, the head and the body rather than trying to think of it as two separate tracks, you’re going to have better outcomes overall.
“That’s very much foundationally what we’re doing as an organization.”
Point32Health also has a value-based care arrangement that is focused on care outcomes as well as population health with the addiction treatment provider Eleanor Health. Similar to Cortica, Eleanor Health was founded around a value-based care model and is purpose-built to track and improve care metrics.
Eleanor Health and Point32Health announced their deal in December 2021.
Companies featured in this article:
Behavioral Health Center of Excellence, Cortica, Point32Health
