Value-based care efforts in managed care that involve behavioral health could lead to better savings and health outcomes across entire populations.
But to get there, payers should expect to spend more on behavioral health, and providers should expect to increase patient engagement.
“There’s been a point of recognition that more behavioral health care is better,” Shana Hoffman, CEO and president of Lucet, said at Behavioral Health Business’ event VALUE. “At the end of the day, I’m trying to drive outpatient utilization alongside what’s going on from a physical health perspective.”
Lucet, the new name of the now-merged companies New Directions Behavioral Health and Tridiuum, offers technology services for payers and behavioral health providers. A core Lucet service is acting as the go-between for plan members seeking behavioral health and getting them placed with a provider with an opening that supports that member’s needs. Lucet can schedule health plan members directly onto providers’ calendars.
In doing so, the company seeks to drive more insurance plan members into largely outpatient behavioral health settings, potentially driving up the cost of behavioral health spending on the part of payers. However, Hoffman said increased spending in behavioral health is vital to lowering overall health care spending, especially related to more expensive physical health issues.
“There are ROI discussions that follow and you figure out this question of attribution and where that risk sits and who’s paying for that,” Hoffman said.
For example, a large multi-million-member health plan that Lucet works with has a 9% rate of behavioral health diagnoses. That number should be around 30%, Hoffman said, but it isn’t due to underdiagnosis and underutilization. Further, 35% of those with a behavioral health diagnosis had no behavioral health claims in the previous 90 days.
Jake Schwartz, co-founder and interim CEO of Brave Health, said payers and providers that share outcomes data should take on a relationship like that of the California Public Employees’ Retirement System (CalPERS) and hedge fund manager.
“Our job, as a scaled provider, in this case, is to provide certain elements that help them earn a better return and manage their resources in a more efficient way to achieve patient services and business goals,” Schwartz said. “If we don’t do that, we should get fired; if we do a great job at that, we should get paid. It’s that simple.”
That kind of thinking is rare in the space where Brave Health works, Schwartz said. The company provides digital behavioral health services for managed care organizations on a value-based care approach.
Behavioral Health BusinessSchwartz, who previously launched a tech startup in the education space, finds that negotiation talks with payers and behavioral health providers are incorrectly zero-sum. In part, this comes from the history of payers with behavioral health. It should change once you have the data and understand the possible returns.
One way Brave Health delivers value is by working with care management organizations in managed care organizations that may struggle to place members in areas with high demands for behavioral health services. This way, Brave Health also connects deeply with members and is delivered where care is needed the most.
Groups Recover Together, a hybrid care provider focused on group-therapy-supported addiction treatment, uses community and population engagement strategies it has developed over the years, Cooper Zelnick, the company’s chief revenue officer, said. But it’s not until after the company finds success in engaging a value-based care population that the payer goes out of their way to help with member data and discovery.
To some degree, payers have these types of functions already. Delegating them to a provider in a value-based care contract may be unnerving to payers. About 97% of Groups Recover Together’s revenue comes from value-based care contracts.
Luckily, engagement strategies at Groups Recover Together have been successful without wide engagement with payer partners’ data. It is, however, not covered in fee-for-services reimbursement models. Medicaid fee-for-services would only cover about 25% of the company’s costs to provide care.
But once the company demonstrates effective outcomes, conversations around measuring outcomes and value lead to simpler reimbursement structures.
“What payers are trying to do, I think, is ‘We’ve been burned by providers before; we don’t want to take your word on outcomes,'” Zelnick said. “Then as soon as those outcomes are there, everyone’s like, ‘Oh my God, can’t we just convert this to a case rate.'”Â
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