Evidence-based care typically means that clinicians have been trained in research-backed practices, but there is no consensus in the industry. Thus, the term “evidence-based” may be as helpful in determining quality of care as the “natural” label is for deciding which jar of peanut butter to buy, industry insiders told Behavioral Health Business. While couching care practices in evidence is crucial, the behavioral health industry may have a single-minded approach to evidence-based care.
“When we talk about evidence-based care, most people are using it very loosely,” Alethea Varra, senior vice president of clinical care at Lyra Health, told Behavioral Health Business. “The majority of providers don’t practice that treatment with fidelity. The term itself has gotten watered down.”
Lyra is a digital provider of mental health benefits, available to over 15 million people worldwide. Founded in 2015, the company has more than $680 million in venture funding.
What is evidence-based care?
The concept of evidence-based care came into vogue within the last twenty or so years, Varra said.
“A decade ago, or certainly two decades ago, there was a dichotomy in how people thought about evidence-based care,” Varra said. “There were academics who were doing these rigorous, manualized treatments, and that’s evidence-based care. There were people who believed in that truly but there were a lot of people who said, ‘Those are academically based. They’re not something you can translate into everyday practice.’”
As more research was conducted, approaches broadly shifted to become rooted in evidence. Now, most providers train in evidence-based care.
“It’s actually a little bit difficult to find a treatment setting or mental health treatment setting, that doesn’t say they do evidence-based care,” Varra said. “But when you dig underneath that a little bit, that doesn’t actually bear out in terms of their day-to-day practice.”
Evidence-based care, as defined by the American Psychological Association, is the “integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”
In practice, evidence-based care is not always straightforward. It requires an intersection of three concepts, David Jones, chief medical officer and director of medical operations at Anthem Blue Cross Blue Shield Georgia Commercial, told Behavioral Health Business.
“One is scientific evidence,” Jones said. “The second is clinical judgment. And the third is a patient’s values and preferences. It’s applying those elements to medical practice to help optimize decision-making and clinical management.”
Anthem Blue Cross Blue Shield Georgia is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The health plan has 4.1 million members and 5,500 associates.
Some evidence is stronger than others, Jones said, requiring physicians to use their own judgment on what practices to employ.
The third element of evidence-based care is ensuring the right type of evidence-based care is applied to each patient.
“Every person is different,” Jones said. “The scientific evidence, our clinical judgment and knowing this patient all comes into play to … tailor to this situation and this patient.”
There is no one-size-fits-all when it comes to evidence-based care. As a result, Lyra uses an AI-driven platform to match patients to providers.
“It’s not just saying, ‘Oh, here’s the provider who is licensed in your state, congratulations, you’re matched,'” Varra said. “It’s really saying, ‘Here’s a provider who we know has been effective with people who are struggling with exactly what you’re struggling with, over and over and over again. They are our top recommendation because we know if you go to see them, your chances of getting better are way higher than if you go see some other random therapists out there in the world.”
Lyra also practices evidence-based care, Varra said, by recruiting people who actively demonstrate a commitment to evidence-based therapy, providing over 100,000 hours of APA-accredited training and consultation for its clinicians in a single year and having standing consultations with providers to regularly review cases.
If not evidence-based care, what should be the focus?
Focusing on the phrase “evidence-based” ignores the real problems in the behavioral health industry, Mill Brown, chief medical officer at Spring Health, told Behavioral Health Business.
New York-based Spring Health began as a business-to-business behavioral health organization with over 4,500 clients, including Microsoft, The Hershey Company, JB Hunt, Bumble and Fujifilm.
“I hear it all the time – ‘Are you doing evidence-based therapy?”’ Brown said. “Yeah, we sure are. We have a lot of people who do evidence-based therapy. But the point is, can you get people in care?”
While evidence-based practices matter, Brown said, they are only one element of providing proper care.
“In our world, we’ve focused on what’s evidence-based therapy instead of access to care or therapeutic alliance,” Brown said. “Getting that connection and staying engaged in care are actually the critical components, then it’s evidence-based care.”
Using evidence-based practices can improve access for patients, Varra said.
“Protecting quality is protecting access,” she said. “People try to draw a line between access and quality and I think that’s the wrong approach. … One of the ways that Lyra is able to maintain access is that the people who come to Lyra actually get better and they get better faster, so they graduate from care. That opens up another spot for somebody else to come to care.”
Although some providers may think evidence-based care may be overblown, it remains an important factor for payers.
Anthem Blue Cross Blue Shield Georgia Commercial develops, adopts and vets programs through an evidence-based lens.
“Any vendors we use or vet to ensure that what they provide is evidence-based, meets our member’s needs and is aligned with our approach to evidence-based medicine,” Jones said.
Evidence-based care is crucial, Jones said, but it’s still important to evaluate care to determine if it’s genuinely evidence-based.
“It’s important to have a skeptical eye to say whenever you hear or see that,” Jones said.
While there may be reason to question the behavioral health industry’s focus on evidence-based care, employing evidence-based measures is still critical for patient outcomes.
“When you get the right treatment to the right diagnosis for the right person, you see much, much stronger recovery outcomes, longer lasting outcomes in terms of that recovery, and really, life-changing experiences in therapy,” Varra said.