Payer Demands for Access Set the Bar for Value-Based Care ‘Really Low’

Despite years of discourse surrounding value-based care and behavioral health, payers remain fixated on access as the primary concern.

Meanwhile, outcomes data and measurement-based care, which have dominated the value-based conversation over the past few years, will likely be important to contracting in a few years.

“By bringing access [to members], you bring value,” Dr. Nick Dewan, vice president of behavioral health at GuideWell and Florida Blue, said during the Behavioral Health Business VALUE conference. “I think once we do that, then we can go on to measuring results… cost and outcomes.”


Guidewell is the parent company of Florida Blue, a health plan that covers more than 5.9 million Floridians and has $30 billion in annual revenue. 

Dr. Nick Dewan, vice president of behavioral health at GuideWell and Florida Blue, speaks during the Behavioral Health Business VALUE conference

Access, access, access 

Like many health plans, Guidewell has sought to combat the access issue by partnering with a digital health company. In this case, Guidewell has partnered with and has a majority stake in digital behavioral health company Lucet. Through this relationship, Lucet is able to help Florida Blue members find an in-network behavioral health provider and schedule an appointment.

Access is a significant issue and payers are willing to pay more for timely, speedy care. Still, this focus on access may mean other measures, such as evidence-based care, are not prioritized.


“We’re at the point where we’re paying extra just for access,” Dr. Taft Parsons III, vice president and chief psychiatric officer of CVS Health, said at VALUE. “I don’t think that we’ll ever get to the point where we can say this person isn’t using evidence-based practice. Therefore, we don’t need them in the network. I don’t see that in the near or foreseeable future.”

CVS Health (NYSE:CVS) is a health care company with a retail pharmacy, a pharmacy benefits manager, and an insurance plan called Aetna. 

Dr. Taft Parsons III, vice president and chief psychiatric officer of CVS Health, speaks at VALUE

Payers aren’t the only ones prioritizing access in value-based care conversations. Providers also see access as the first step to enabling larger conversations about value measures.

“Access is a value to providers; access is a value to patients. Access is not an outcome. It’s a process measure or a proxy for an eventual good outcome,” Dr. Navdeep Kang, chief quality officer of Inpatient Services Acadia, said at VALUE. “Again, whether it’s total cost of care reduction, or providers being able to scale more rapidly … it is ultimately a means to an end. We do have to start where we start, and we have a supply-demand imbalance in this industry. So we have to bring more care to the market. But it’s also a very valid question: what is the nature of the care we’re bringing to market.”

Acadia Healthcare (NASDAQ: ACHC) is a behavioral health provider with more than 253 facilities and roughly 11,100 beds across 39 states.

Access is a start, but quality is priority 

Payers are working out how to boost access while ensuring that the care members receive is of a high quality.

“I think that access is kind of where we’re at [with value-based care],” Parsons said. “But it’s unfortunate that that’s where we’re at, because that is setting the bar really, really low for behavioral health. One of the things that we also know is that all care is not good care.”

Still, figuring out the proper measures for all behavioral health providers to use to prove quality can be tricky.

“We don’t have a great way to measure what good care really is,” Parsons said. “It’s going to be different across different treatment settings. For example, an outpatient clinic that treats people with mild to moderate illness doesn’t care about the rate of seclusion and restraints. Whereas an inpatient facility really should care about the rate of seclusion and restraints; that is a sign of quality in an inpatient setting.”

Defining that value comes down to defining your patient population and where they are getting treatment, then figuring out what is valuable to the provider and to the payer, according to Parsons.

In addition to clinical measures and cost savings, value-based care should include the patients’ priorities.

“When we think about value as clinicians, we also think about the patient and what’s valuable to them– the experience of care, functional improvements in terms of quality of life,” Kang said. “I think that’s often lost in the discussion as well.” 

Dr. Navdeep Kang, chief quality officer of Inpatient Services Acadia, speaks at VALUE

However, with so much variation, payers and providers can run the risk of creating new value measures for each contract.

“I think the macro difficulty is finding alignment. What are we using to define quality? How are we measuring it? And then, ultimately, what are we looking for in the longer term? And how are we marshaling all of that data,” Kang said. “From both sides, the typical challenge is to agree upon all those metrics for a specific patient population. So every time you’re having a conversation, either from the plan side with a provider or from the provider side with the plans, each of those conversations is unique; each one is siloed.”

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