Value-based care is a buzz word in the behavioral health sector. But few organizations in substance use disorder or mental health have built their care model solely based on a value-based approach.
Eleanor Health, which was founded in 2019, was one of the first providers to take a population-based and value-based care approach to treating substance use disorder (SUD). The tech-backed provider has raised more than $82 million since its inception to build the hybrid care company.
Recently, Eleanor has undergone several changes. One of the biggest to note is that its founder and CEO, Corbin Petro, decided to step down.
But Petro’s journey in creating and searching for innovative payment models is hardly over. Instead, Petro is transitioning into an advisory role and keeping her seat on the board of directors.
Petro sat down with Behavioral Health Business to discuss the future of value-based care in the SUD space, integrating behavioral and physical health care, and lessons learned in the industry.
Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: You recently decided to step down from your role as CEO at Eleanor Health. Can you tell me about that transition and what’s next for you?
Petro: I’m still incredibly passionate about Eleanor and very much involved. I moved onto the board from the CEO role toward the end of August. And that was to be able to continue to provide the vision innovation that we know is so important to drive this model forward, and to really hand the reins to somebody to scale all the amazing work that we’ve done across the seven states that we’re in.
We just signed about five or six new value based contracts over the summer so the organization is positioned well for scale. We’re ready to put that organization into the hands of an operator to really scale the model.
There has been a lot of buzz about value-based care over the last few years. You have been one of the pioneers in the space. What are some misconceptions about value-based care that you’ve heard?
Often when founders and others approached me on helping them get into value-based care contracts, what they really are looking for is higher reimbursement, which can be part of value-based care. But the way I think of value-based care is when you’re delivering any type of intervention in health care, you have to think about who is extracting the value and what value are you creating. Sometimes it’s directly for the patient, sometimes it’s for health systems, payers, or whoever’s supporting the reimbursement.
Most value-based models that I think are successful are figuring out and quantifying what that value is, and then sharing in the reward of that value. What we see in substance use disorder and how we approach it at Eleanor is that our model reduces the total cost of care of the patients who we serve. We see it in the data time and time again, consistently in tens of thousands of patients that we reduce the spend, but it’s largely on the physical health side.
So the behavioral health spends sort of sits on one side and the medical spend sits on another, and it’s really archaic when you think about it because the brain controls so much of what happens with the body — and vice versa. There’s no way to separate those two; they’re inextricably linked. Being able to communicate that and quantify that with payers we’ve been able to share in some of those cost savings.
What are some lessons you’ve learned about implementing value-based care in the SUD space over the past five years?
I think it’s really hard to try to operationalize a fee-for-service model, and a value-based model. With Eleanor and with many of the companies that are really succeeding in value-based care, they’re purpose built for value-based care.
We don’t try to make money and bill for things that we know don’t drive positive outcomes. In the substance use disorder space, urine drug screens and utilization of higher levels of care are the two [services] that don’t always drive positive outcomes, but are often leaned on to reimburse.
So lean in on the value that you’re creating as a provider and don’t sway from that because the fee-for-service system that we have in America really does incentivize you to do things that may or may not drive quality outcomes. If you’re trying to change the paradigm of reimbursement you really have to pick that lane.
There’s been a lot of talk about value-based care needing an integrated approach between physical and behavioral health. How does that work in SUD? What are the challenges?
The broader behavioral health industry and substance use disorder are really in the early stages of developing a core set of metrics that makes sense for this space.
When we started Eleanor, it was all about negative urine drug screens and retention. When you think about those two measures, it really incentivizes providers to cherry pick patients who are the most compliant. It also encourages firing patients for non-compliance to certain measures and metrics.
We’re in the early days. We think of the measures and metrics in this space, much like we think about population health where we’re really looking to improve the population that we’re serving. So if your starting point was an opioid use disorder, we look to reduce your cravings, improve your anxiety, improve your depression, reduce substance use, as opposed to saying you’re only successful if you completely stop using opioids.
My advice for the industry is to benchmark and baseline individuals and populations and then improve those.