Digital Behavioral Health Providers Poised to Deliver Coveted Outcomes Data, but Contracts Remain Customized

Payers and employers are moving away from a strictly fee-for-service model and looking for outcomes from behavioral health providers.

As the transition to outcomes-based payment gains momentum, digital health providers might be well-positioned to partner with these entities because of their data-collecting capabilities.

Behavioral health providers have traditionally lagged behind physical health providers when it comes to implementing technology. This can make it harder to collect outcomes data to share with key stakeholders.

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“We need to be able to reimburse for outcomes and measures rather than just for the service,” Melissa Reilly, chief growth officer at Evernorth Behavioral Health, said at Behavioral Health Business’ VALUE conference. “So that is the mentality that we’re thinking about in each of the models that we start to put forth, both with our provider partners and with the systems that we’re working with.”

Evernorth is The Cigna Group’s (Nasdaq: CI) health services division. The St. Louis-based company has partnered with several digital behavioral health companies, including NOCD, an OCD-focused digital health company, substance use disorder provider Bicycle Health, and addiction treatment platform Quit Genius. 

Melissa Reilly, chief growth officer at Evernorth Behavioral Health, speaks at BHB’s VALUE

Unlike their brick-and-mortar counterparts, the bulk of digital health providers have the ability to track data over time.

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“[Data allows] you to expand your pool of information available, so you can start to gain valuable insights,” Dr. Nikole Benders-Hadi, chief medical officer of Talkspace, said at VALUE.

New York-based Talkspace (Nasdaq: TALK) is a virtual mental health provider that offers teletherapy, medication management, and asynchronous messaging. The company has recently ramped up its partnership strategy with youth-focused deals with the city of New York and state of California.

Still, those outcome measures might be distinct for every tech-enabled partnership based on the patient population. Behavioral health doesn’t have a single national industry outcome measure, which has historically been seen as a pain point for the industry, Benders-Hadi said.

“But I actually think that that’s a little bit of an oversimplification,” she said. “The fact is that we serve a diverse pool of patients. How you treat someone with depression versus anxiety or PTSD versus substance use disorder is very different. So to be able to have access to more data and break down that data to different outcomes measured, depending on that particular patient’s need, is really important in the unique advantage [for digital providers] for sure.”

Dr. Nikole Benders-Hadi, chief medical officer of Talkspace, speaks at VALUE

It’s also essential from the payer perspective to not rigidly create a set of outcomes data that all providers must collect.

“What we want to be very careful of is that we are not dictatorial on the measures right now,” Reilly said. “Since there is not a nationally identified standard measure, we must be very careful that we leave openness for patient choice and provider choice and do no harm as this industry continues to evolve.”

While there is still quite a bit of flexibility on the right metrics to collect with these digital partnerships, standardization could mean some companies are taken more seriously.

“I think that we are in the early stages; collaboration is important, and engaging clinicians in that voice is important,” Alisa Bahl, president of the Bahl Group, said at VALUE. “However, I would say, if we’re going to be taken seriously as an industry, we’re going to need to come up with some standards that we can all get behind. And I haven’t looked at a PE-backed company yet that didn’t walk in and tell me about their GAD-7 scores, their PHQ-9 scores and their ability to move the needle.”

The Bahl Group is a consulting firm specializing in health care investments, film and media production, horse racing and philanthropic giving.

Two-way partnership 

Payers and employers may be looking for very specific outcomes for their populations and each partnership will be reflective of this.

A company’s top priority may be based on a recent event, trend, or pain point happening internally. For example, Bahl noted that if an employer has seen an overdose loss in their population, they might be more attuned to thinking about how they can make their workplace safer.

“I think for employers, there are special populations they want to serve, particularly if there’s sensitivity within their C-suite,” Bahl said. 

Alisa Bahl, president of the Bahl Group, speaks at VALUE

But there are some universal assurances that most payers and employers are interested in including decreasing emergency room utilization, engagement and patient retention, Bahl noted.

“The top of the pile is definitely access, as well as things like clinical outcomes. And the way that you get to outcomes is with engagement,” Benders-Hadi said. “So, we’re looking for assurances around levels of engagement. So again, the provider base, how we are teaching them, training them on enhancing engagement, preparing patients for sessions, setting expectations for therapy, as an example, is how we get there.”

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