Big Payers Want Behavioral Health Partners That Can Be More Than ‘A Flash In the Pan’

Behavioral health point solutions are increasingly looking to make lucrative payer partnerships.

Payers, too, are interested in the prospect of partnering with digital health companies to provide more behavioral health services to their members. But there can be a culture clash between the two entities. Thus, it’s crucial to have aligned goals, outcomes and expectations, stakeholders from both sides say.

“Many of us have more than 50% of the market share in the state we live in,” Suzanne Kunis, vice president of behavioral health at Horizon Blue Cross Blue Shield of New Jersey, said at HLTH. “We have the ability to change how things happen there.”

Horizon Blue Cross Blue Shield of New Jersey is a health insurer that provides coverage to 3.8 million people.

Behavioral health has become a major focus for payers as rates of depression and anxiety continue to skyrocket. In response to this crisis, more than $5.5 billion in venture capital has been invested in digital health solutions.

“There is advanced conversation, new innovation, the largest investment from venture capital in behavioral health – ever,” Cara McNulty, president of behavioral health and mental well-being at CVS Health (NYSE: CVS), said at HLTH. “So the art of possibility is here, but we all have to take it and put it into action so the people we serve really feel those results.”

CVS Health is the parent company of Aetna.

Specifically, payers are looking for areas where they have the greatest opportunity to make an impact, Kunis said. This means addressing high-cost areas with high demand. Niche solutions that can only cater to a small population will be lower on a payer’s priority list.

It can also help when payers understand where a point solution fits into the care continuum.

“The way we look at it is, what are the problems we see as most important for our clients that we need to solve short, medium and long term,” Eva Borden, president of behavioral health at Evernorth, said at HLTH. “It’s really being able to plot out startups and say who falls into which group, and who has a long-term trajectory. Not just to be the flash in the pan today, but you can see that they can build.”

Evernorth is the health service division of payer giant Cigna Corp.’s (NYSE: CI).

Red flags 

With hundreds of behavioral health point solutions on the market, finding the right fit can be a daunting task for payers.

“It’s a huge amount of work to try to set up these kinds of relationships,” Kunis said.

This can put additional pressure on startups to get the initial interaction right from the start. But honesty may be the best policy when forging payer-point solution partnerships.

“When you do get the opportunity to pitch a health plan, do yourselves a favor – be honest,” Kunis said. “Tell the truth. Where are you? What’s reality? Don’t make up a story that’s not going to come through.”

Being upfront about what problems a point solution can solve and cannot solve is helpful for payers, McNulty said. Specifically, it can help payers understand where that solution fits in the health ecosystem – and set appropriate expectations.

Overall, payers are looking for stability both in the products and leadership team, Kunis noted. And flashy offers will not necessarily work to woo payers.

“When you come in and start telling me from Day 1, that you’re going to take a [risk-based approach] on my membership, that’s a major red flag for me,” Kunis said. “All that means to me is you’re a startup, you got some VC behind you with a bucket of money that’s saying, ’Let’s go in there, make it easy for them.’”

It’s also ok to ask questions, Borden said. If a potential partner isn’t an expert in health plans and isn’t sure about the health ecosystem, it’s better to ask than to guess.

A pathway to partnership

To help make the payer-point solution partnerships easier, many payers have set up a formal process where startups can pitch their solutions.

For example, CVS has a team dedicated to partnerships. It also has a strategy that pinpoints gaps and needs. This strategy is then used to help it assess potential partners. The team assesses over 500 potential partners a year. Additionally, on a quarterly basis it has a “shark tank-like” process that evaluates potential partners.

“I want to know what you’re solving and why,” McNulty said.

It’s also important for payers to see point solutions as true partners and not vendors. A key part of creating that partnership is aligning goals.

“We can have an honest dialog about what those aligned goals are,” Borden said. “That’s when I see partnerships going a long way because it’s really a virtuous way of helping each other.”