As part of one of the country’s largest ‘payvider’ organizations, Evernorth is positioned to help set the course for the future of integrated and measurement-based care in behavioral health.
Evernorth is the health service division of large payer group Cigna (NYSE: CI). It offers a wide range of behavioral health and substance use disorder services. The health service organization has also prioritized digital health partnerships, including deals with Bicycle Health, NOCD and Pelago.
Earlier this month, Evernorth announced a new behavioral health measurement-based care program. The provider designed the latest initiative to improve care, cost and collaboration while removing administrative barriers for providers.
Behavioral Health Business sat down with Dr. Doug Nemecek, chief medical officer of behavioral health at Evernorth, to discuss integrated care, value-based care and the industry’s future.
BHB: Integrated care has become a hot topic recently. How is Evernorth looking to integrate behavioral and physical health care further?
Nemecek: You need both physical and emotional health if you want to reach your optimal potential. For example, when one of our members is diagnosed with breast cancer, she is not only focused on what her oncologist is telling her, but she can be overwhelmed with anxiety. She may be thinking about how her appointments will impact her work schedule and worried about how she will care for her children or how this will affect her relationship with her husband.
An incredible range of emotions can occur in the face of a cancer diagnosis. So it’s important that we surround that individual and their family with appropriate behavioral health resources and support.
In addition to providing comfort in a difficult time, high-quality behavioral health care also impacts the bottom-line outcomes. Our research has found that oncology patients who don’t get behavioral health outpatient care are twice as likely to have avoidable ER visits, which can cost their health plan sponsor $173 to $243 per member per month more than those with cancer who seek outpatient behavioral health care.
Integration has both clinical and functional outcome improvements.
Is that integration mainly through referrals or co-locations?
It’s really about ensuring all of these providers are connected. Sometimes, that resolves from co-location, but often, it’s just about making sure that we help all providers understand who else is in the treatment path for individuals.
The other part that is important from an integration perspective as the health plan and at Evernorth is that it gives us the ability to leverage the data that we have across medical, pharmacy and behavioral health so we can potentially identify individuals before they raise their hand for help and before one of our physical providers recognizes that there is something requiring more significant support.
It allows us to do outreach and engagement and get members involved with behavioral health as part of their integrated care sooner.
A recent report from Evernorth found that 22% of patients have a diagnosed BH condition, and they account for 41% of the total health care spending. How can an organization like Evernorth help address the rising cost of care for behavioral health patients?
One of the most important interventions is the ability to engage members in high-quality behavioral health care quickly and make that behavioral health care journey simpler.
The research that you mentioned is important, and the research we published in JAMA showed that receiving behavioral outpatient care for patients newly diagnosed with behavioral health conditions, anxiety, depression, substance use, whatever it may be, is associated with a reduction in total medical costs up to over $2,500 per person over the first 15 months following a diagnosis, and $3,300 a person over the 47 months following that initial diagnosis.
Evernorth has a robust digital health behavioral health strategy. Is Evernorth continuing to seek digital health partners? What does that look like?
We are excited about some of the advancements we’ve seen in digital health and the partners we’ve started working with over the last few years. We’re always looking to engage with new and innovative providers that can advance our ability to serve individuals and assist them with getting the care they need.
Within Evernorth, we have a structured governance process where we evaluate the strengths and value of these prospective digital companies. We look at our needs, our members’ needs, our clients, and our existing capabilities.
One of the primary challenges overall is helping people understand what resources are available. Most people aren’t familiar with the names and services of these digital providers. So we’re spending a lot of time ensuring we assist people with understanding some of these care options.
What areas of behavioral health are ripe for innovation?
The behavioral health system is so complicated for people. I think that’s one of the biggest challenges we face. We’re focused on providing better tools and resources that help people understand the mental health and substance use disorder issues they’re facing and how to access resources and support.
We’re also looking at creating more specialized resources, especially digital ones. We have programs focused on a specific diagnosis or patient population, the LGBTQ+ community, for example. This innovation helps us personalize care.
The other opportunity is how do we bring more automation into places where there is inefficiency.
Can you tell me a little bit about the new measurement-based care program from Evernorth?
To better align on quality care and reimburse providers for delivering improved health outcomes for patients, we are launching an innovative measurement-based care program for our behavioral health network.
The goal of the program is to align on measurements that can ultimately drive improvements in care, cost, and collaboration, as well as remove administrative burdens for providers. By embedding shared metrics in the customer journey, both payers and providers will develop insight into access and outcomes that will benefit everyone.
We’ve discussed value-based care with Evernorth before, but where are you on that journey? How does behavioral health fit into value-based care?
We’re excited about value-based care and increasing partnerships with providers.Evernorth Behavioral Health CMO: ‘Measurement-Based Care Leads Directly to Conversations About Value-Based Care Contracts’ and innovative contracts. As we evolve that contracting in addiction to including measurements, we’re also working to simplify the process.
We’re also working to simplify processes to ensure the data and metrics are transparent again to help build that trust in this process.
Many provider groups are really receptive and energized by this approach with us. We’re excited that this innovative value-based measurement-based care is moving forward rapidly. We expect and will see some of our first innovative value-based type care contracts coming out in the next few months. What we learn from that to evolve and scale from there will allow us to work to move this forward exponentially.
The other place we’re working to drive value-based care around behavioral health is with physical health partners. We embed behavioral health metrics and outcomes in some value-based contracts for primary care physicians, for example, to help ensure that the integration and coordination of care is incentivized and addressed everywhere that it can be.
