Payers Must Create Infrastructure to Support Behavioral Health Providers Moving Towards Value-Based Care Contracting

While the medical community agrees that integrating behavioral health and primary care is critical to better patient outcomes, making that happen means disrupting the status quo.

Industry stakeholders are rethinking the current reimbursement structure to promote integrated care. But to shift the current paradigm, payers and providers must work together to navigate uncharted territory.

Roughly 15% of primary care visits in the U.S. address a behavioral health concern, according to recent data from Health Affairs. Yet, full integration of services is rare, making it difficult for primary care providers to help patients find appropriate behavioral health services.


Some health systems are pioneering integrated care approaches but are coming up against reimbursement hurdles. For example, Mount Sinai has taken a multi-pronged approach to integration, Dr. Anitha Iyer, director of behavioral health and population management at the health system, said at The Future of Mental Health East Conference. 

Mount Sinai Health System launched its Primary Care Behavioral Health Program, where a psychologist is co-located in a primary care setting and can help care for patients with comorbid medical conditions. The program is designed to help drive health behavior changes and is targeted at reducing overall medical costs.

However, only about 50% of a psychologist’s salary is covered through fee-for-service revenue because psych CPT codes do not reimburse at the same level as medical, Iyer said.


“I think shifting the focus to whole-person care is an important vision and one that we’re all bought into,” Iyer said. “But until we’ve got the payer system at large buying into it, … it’s going to be a difficult strategy to scale.”

New York-based Mount Sinani is an integrated health care system. Its network includes more than 7,200 physicians and 13-free standing joint venture centers.

The fee-for-service model may not be set up to truly integrate care. But many payers and providers are looking to value-based models to help move the dial in that direction.

“So we spent a ton of time looking at fee schedules, increasing rates, but we also started to move towards value-based care on an outpatient basis,” Suzanne Kunis, vice president of behavioral health at Horizon Blue Cross Blue Shield New Jersey, said at the conference. “We’re trying desperately to move that along as fast as we can – not so easy. Providers aren’t necessarily prepared for that. And we need to be able to open our eyes and think a little differently about things.”

Horizon Blue Cross Blue Shield New Jersey is a nonprofit health insurance company. Its total revenue is roughly $13.6 billion annually. It employs 5,6000 people and has 3.7 million members.

Even if providers are interested in jumping into a value-based care contract, they may need substantial payer support to help them get started.

“I think what’s really important to decrease the fragmentation is to have the providers, as well as the health plans, systems, working together – each have a very important role,” Rhonda Robinson Beale, SVP and deputy chief medical officer of mental health services at UnitedHealth Group (NYSE: UNH), said at the conference. “I think health plans are realizing and working towards value based contracts. They also realize providers need the infrastructure and the support to do that.”

Minnetonka, Minnesota-based UnitedHealth Group is a for-profit health insurance company. In 2022, its annual revenue was $324.2 billion.

Robinson noted that she began her first value-based care contract in the 1980s when these arrangements were still brand new. During that time, it was essential to have the payer guiding her and putting in a safety net for her practice.

“My practice was small. I could not take on a capital risk without the company saying we’re going to trust you, and we’re going to be your partner,” Robinson said. “They created an escrow account. The escrow account was a fallback because I was taking full capitation and stepping into the well right away. And it worked. It worked in the sense that the first year is your hardest year in terms of learning how to get your systems together and understanding the health plan.”

If done correctly, she continued, a value-based care system can make it easier for patients to access care and understand where they need to go next.

“I also learned that the health care payer acting like a system is a great partner. Because you know what’s going on, the members know who to call,” Robinson said. “That’s a great triage place to say, ‘Okay, you belong to this provider. And I, as a provider, am accountable.’”

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