Eating disorders often go untreated. And when treated, it’s typically during a crisis, driving up care costs.
But value-based care models could help lower the total cost of care by providing access to lower-acuity treatment and integrated care teams. Payers expanding access and wrap-around services to patients with an eating disorder often see cost savings on the medical side, perhaps even more than on the behavioral health side.
“If you were to take Cigna and go through all of the claims that have at least one eating disorder diagnosis on a claim, 80% of those people will be in the top third of the spend,” David Willcutts, CEO of Accanto Health, said at Behavioral Health Business’ VALUE. “Think about that top third of the spend. Yet of that same cohort, only 12% to 15% are receiving any disorder-specific care.”
Accanto was formed in 2021 following the merger of eating disorder providers The Emily Program and Veritas Collaborative. The St. Paul, Minnesota-based provider has 20 locations across seven states.
More flexible models
How the system is set up often leads to patients either going to an inpatient facility or not getting care at all.
But new payment models could help patients access care virtually or in an outpatient setting.
“We don’t want to overdose people on treatment that they don’t need,” Kristina Saffran, co-founder and CEO of Equip, said at VALUE.
Equip was founded in 2019 as a company that provides virtual family-based treatment (FBT) for individuals living with eating disorders. It does this through a team-based approach. In 2022, it announced a nationwide expansion and closed a $58 million Series B funding round.
In Equip’s model, each patient gets a therapist, dietician, medical doctor, peer mentor and family mentor. Peer and family mentors are the “real secret sauce of the program,” Saffran noted.
This model is flexible and allows patients or family members to access the care team for support around the clock. The integrated care model couldn’t work in a fee-for-service environment, Saffran said.
“To do that, we needed to create some sort of alternative payment arrangement,” she said. “I think we work incredibly collaboratively. We’re incredibly transparent in outcomes. We now can take upside and downside risk. And as the business continues to mature and we get more data, we want to continue to move towards getting paid for patients getting better.”
What payers want
Alternative payment arrangements take trust, cooperation and ample data between payers and providers.
“When we start to think about contracts and value relationships, [we] look at … outcome measures, which are vital and we need to include,” Dr. Doug Nemecek, chief medical officer of Behavioral Health at Evernorth, said at VALUE. “But how do we also look at things like [access].”
Access, Nemecek said, could refer to providers’ ability to guarantee access to members within a certain period.
Evernorth is Cigna (NYSE: CI)’s health services division. Evernorth has heavily invested in behavioral health in recent years, with its behavioral health network doubling in size. It has also made deals with a number of behavioral health tech companies including Quit Genius and Alma.
Many providers are already collecting this data to show payers. For example, Equip tracks comorbidities like anxiety and depression, caregiver burden and rate of weight gain. And Accanto looks at PHQ-9 and readmission rates.
In addition to health outcomes, many payers and providers are looking at the cost savings. Investing in eating disorder treatment may help payers lower their physical health spend on patients.
“We go down a layer deeper. That is where we’re really having the most interesting conversations on a payer level about – what’s the total health care spend,” Willcutts said. “We tend to talk about the eating disorder, and what’s happening with the eating disorder and that spend. But we’ve done some pretty deep work on what the total spend is of this population. And it’s a massive number, and it’s not being spent on eating disorder care.”
Since eating disorders are strongly correlated with physical health care needs, many payers struggle to understand their spending on these patients, Saffran said.
“There’s so many hidden costs,” Saffran said. “This is also a population in which … half of all kids and adolescents who end up in a hospital for an eating disorder … have never had any past outpatient treatment.”
Many patients with eating disorders have gone from costing payers no money to a lot of money in a very short period of time because of inpatient visits, she explained. Value-based care could instead provide lower acuity interventions before a patient needs hospitalization.
This kind of integrated approach to care requires alignment between the physical and behavioral health provider. A value-based contract also needs to reward behavioral health providers for some of the cost savings on the physical health side.
“You can’t do good family-based treatment [of eating disorders] economically,” Willcutts said. “The only way you can do it is if you’ve got other services that pay for the losses because … no one’s going to pay you for doing a 10 p.m. call.”
Companies featured in this article:
