Optum, Aetna and UHS Leaders Offer ‘Outcomes Roadmap’ for Value-Based Contracting

Behavioral health providers have lagged behind their physical health counterparts in measuring outcomes.

But that may soon change, industry insiders believe, as payers pressure providers to show more data before raising rates or negotiating value-based contracts. Even so, collecting the correct data to prove outcomes isn’t just on behavioral health companies.

A true outcomes-based approach means data sharing between all parties in charge of care – payers, along with behavioral and physical health providers.

“A day doesn’t go by where I don’t get a phone call from one of our partners asking for higher rates,” OptumHealth Behavioral Health Solutions CEO Trip Hofer said at the Behavioral Health Business VALUE conference. “If you want a higher rate … I need data. I need to see what you are doing.”

And it’s not just any data, Hofer explained.

“I need to make sure it’s actionable. I need to make sure it’s consistent,” he said. “Five years ago, you could have gotten a higher rate because you were loud. Now, it’s based on, ‘I need to be able to see outcomes.'”

OptumHealth is UnitedHealth Group’s (NYSE: UNH) health services division. The Eden Prairie, Minnesota-based organization and its insurance arm manages over 127 million lives.

Many behavioral health providers have aggressively invested in ways to measure their outcomes in complex, meaningful and novel ways. But outcomes can be simple measures built around existing constructs such as the PHQ-9 or GAD-7.

Ultimately, payers need outcomes that demonstrate value to justify raising providers’ rates.

Another significant issue in the behavioral health industry is the lack of uniform outcome measures.

“The challenge, of course, is that all of the measurements are so subjective,” Deborah Fernandez-Turner, deputy chief psychiatric officer at CVS Health’s Aetna , said at VALUE. “It’s based on a person expressing how they feel. We don’t have that clear, quantitative [measure]. We can’t look at a hemoglobin A1C and say, ’Oh, that depression is better.’”

A collaborative approach

Even if a behavioral health provider is collecting measurement-based outcomes data, it can only do so much if its data is in a silo. For example, at Universal Health Services (NYSE: UHS), the company’s clinicians collect data about the number and percentage of patients who saw a statistically meaningful clinical improvement.

Mark Friedlander, chief medical officer of Behavioral Health at Universal Health Services, said this is a good first step. It’s more than the bulk of behavioral health providers are doing, he said, though adding more needs to be more.

King Of Prussia, Pennsylvania-based Universal Health Services is one of the largest behavioral health operators in the U.S. It has about 406 acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care locations across its footprint.

“It’s a necessary step. But it’s something that just hasn’t been done at scale, the way we’ve started to do it,” Friedlander said. “There’s more to it than that. We know that medication adherence is a key component of a good outcome. We need the data from CVS; we need the data from the payers on what happens outside of our system.”

More whole-person data could also help move the dial on value-based care contracts. Individuals with specific behavioral health conditions, including serious mental illness and substance use disorder (SUD), have higher costs of medical care overall.

Getting the right treatment on the physical health side might lower the cost of care. But behavioral health providers are often kept in the dark about what is happening on the physical health side.

Friedlander gave the example of a patient with SUD and chronic pain. This patient is “super expensive to the payers” and requires care from behavioral health providers, pharmacists and physical health providers. If taken care of by all entities, this could reduce trips to the emergency room.

“But we, on the behavioral health side, don’t get the data to quantify that. So we don’t know. How do you share that data meaningfully?” Friedlander said. “We need to be able to share the data so that we can figure out who does what and who contributes what. It’s not all about the dollars and who deserves what share of the pie.”

Friedlander also noted that behavioral health’s lagging adoption of electronic health records could make data sharing difficult.

Looking at data differently

Behavioral health outcomes sometimes take longer to demonstrate compared to physical health outcomes. That reality may also require payers to look at data differently in the future.

“You can’t put a timeframe on the outcomes within mental health,” Fernandez-Turner said. “It takes a long time to move into a recovery space for an individual. So how can we show a return on investment in one year? It’s just not possible. It really takes three years to really see benefits to the work that we’re doing.”

And while integrated, whole-person care might be the ideal, the payer environment just isn’t ready for this change.

Until then, showing the data and proving ROI still drives the ship.

“I would love to get to a point where we’re just like, ‘Okay, listen, this is good for the head and the body,’” Hofer said. “But the reality is that, that’s not what I face in a health plan environment. I have to go in front of actuaries who want to see an ROI. And I daily get in arguments with them, that this doesn’t make any sense. But that’s the reality right now.”