Major payers have increasingly turned to digital behavioral health providers to fill in the gaps in care not met by their present services.
In doing so, these payers seek to address the issues of access, speed to care, specialist availability, convenience and privacy through digital platforms.
In turn, digital behavioral health providers gain access to huge swaths of potential patients, often on an in-network basis. This also allows other payer customers such as employers and government entities to vet the growing number of digital point solutions popping up in behavioral health.
A recent example: Evernorth, the health services arm of the Bloomfield, Connecticut-based health insurer Cigna Corp. (NYSE: CI), announced that it expanded its partnership with New York City-based digital addiction treatment Quit Genius to include alcohol use disorder (AUD) and opioid use disorder (OUD). Evernorth first teamed up with Quit Genius to add its nicotine cessation tool to the digital formulary in 2020.
“[There is] a recognition by incumbent health care companies that digital health is quite frankly here to stay,” Quit Genius CEO Dr. Yusuf Sherwani told Behavioral Health Business.
Pre-pandemic, digital solutions including telehealth were regarded as “an interesting curiosity.” Then COVID-19 forced a large spike in telehealth and virtual care utilization, increasing the number of people who found they preferred telehealth, Sherwani said.
Many people preferred the convenience of being able to interact with providers from anywhere they could use a device and the privacy that afforded them, Sherwani said.
“The idea of telehealth and using digital applications … was a nice-to-have, not a necessity” in pre-pandemic times, Sherwani said. “Quickly we had COVID happen, which much like with remote work, was a forcing function for people for the first time to try out telemedicine. … And they liked it a lot.”
Evernorth also announced a partnership with the digital OUD treatment provider Bicycle Health.
Pent-up demand met by digital behavioral health companies
In August, Empire Blue Cross Blue Shield (Empire BCBS) announced that the digital behavioral health companies Alma, Headway, NOCD, and Ophelia Health were in-network for members.
This announcement helped Empire BCBS in several ways, Jordan Vidor, regional vice president of provider solutions for the organization, told BHB. It added more providers to the Empire BCBS network and better enables value-based care in its network.
“Through these four partnerships alone, we have added north of 5,000 new providers to the network. That alone we thought was worthwhile,” Vidor said, adding that this had a “material impact” in expanding the network and adding new specialties to the network.
Headway saw more than 5,300 Empire BCBS members from June 2022 — when Headway started in network — to August, Vidor said.
But the more impressive statistic to Vidor was the fact that Headway was able to get Empire BCBS members to care in under a week on average.
Through these four partnerships alone, we have added north of 5,000 new providers to the network. That alone we thought was worthwhile.Jordan Vidor, regional vice president of provider solutions, Empire BCBS
Headway makes it easier for patients to get connected to therapists on an in-network basis. It partnered with CareFirst BlueCross BlueShield, which operates the largest commercial therapist network in the Washington, D.C., region, partnered with Headway to help its members get connected to its therapist network via telehealth and other digital infrastructure.
“That tells you a pretty important reason as to why we were so excited to bring these providers in-network,” Vidor said. “[There was] pent up demand and people who have put off care that they really needed for a long time and finally now have a solution like this. … That has immense value.”
The goal is for digital behavioral health services to enable greater treatment adherence, better engagement with care and prevent some degree of downstream health issues, Vidor said. Nearly every behavioral health provider that Empire BCBS works with, especially the new digital behavioral health companies, has asked to engage in some level of value-based care.
Digital health care providers are especially well positioned to engage in value-based care models because they are more apt to measure and understand the data they generate, Vidor said.
Access to specialized care
Digital behavioral health companies help provide access to specialized and hard-to-find care, Stephen Smith, CEO and co-founder of the startup NOCD, told BHB.
His company provides mental health services including exposure and response prevention (ERP) therapy for obsessive-compulsive disorder (OCD). Smith described ERP therapy as the “gold standard” for OCD.
OCD impacts about 2.3% of U.S. adults over their lifetimes, according to the National Institute of Mental Health’s website. That’s about 7.6 million Americans. And Smith estimates that about half of all OCD cases are considered severe.
OCD, which is poorly understood by most providers, manifests as very specific, sometimes taboo, fears that can only be relieved by compulsions. In ERP, patients learn how to respond to fears and improve reactions over time.
You can offer virtual first solutions given that, in some cases, it can be even more effective.Stephen Smith, CEO and co-founder of NOCD
People with OCD commonly get misdiagnosed or don’t often appear in health care claims data, Smith said. So, they rarely get the care they need, or get therapies that don’t address their conditions, and require additional care and generate higher care costs.
“ERP is a treatment that is effectively delivered in a virtual setting based on, not only on our experience, but also research conducted externally and peer-reviewed,” Smith said. “You can offer virtual first solutions given that, in some cases, it can be even more effective.”
In NOCD, people are walked through exposures, where they purposefully trigger fears, and practice acceptance of uncertainty. People may be more willing to do so or find greater convenience by doing it in the privacy of their own homes, Smith said.
Smith estimates that there are no more than 2,000 ERP specialists in the U.S. And those that do practice in the U.S. are often isolated to urban communities, are expensive and don’t operate in-network with health plans, have long waitlists and are therefore out of reach for most people with OCD.
NOCD reduces wait times to several days instead of several months and does so in a more affordable in-network arrangement.
“By partnering with NOCD it’s now a reality for the Empire Blue Cross population where they can live a healthy life,” Smith said. “That includes their families who are supporting them; It’s a whole family that usually is impacted by this devastating condition.”