Racial and ethnic minority groups are 20% to 50% less likely to initiate mental health services and are 40% to 80% more likely to drop out of treatment prematurely.
Some behavioral health providers are seeking to improve these statistics by catering their services specifically to people of color, marginalized individuals and Medicare and Medicaid beneficiaries.
Collecting robust patient data is especially essential when caring for populations that the U.S. health care system has historically underserved, industry insiders said at Behavioral Health Business’s VALUE conference.
Focusing on specialized populations can improve underserved populations’ access to crucial care and better position providers in negotiations with payers and investors.
“It is one of the things that is usually top of mind for payers as well as capitalization partners is how do you strike engagement in a population that has so many challenges and historically hasn’t engaged in healthcare as much as their counterparts,” Evans Rochaste, founder and CEO of ReKlame Health, said.
New York City-based ReKlame provides virtual-first psychiatric care, addiction care and care coordination for BIPOC communities and prioritizes maintaining a diverse clinical staff. ReKlame’s patients receive treatment from a care team consisting of a psychiatric nurse practitioner and a care navigator. ReKlame accepts major insurance plans including Optum, United Healthcare, BlueCross BlueShield and Aetna.
Approximately 55% of ReKlame’s current patient panel identify as BIPOC and about 90% of its care team members identify as BIPOC, according to Rochaste.
Providing care to specialized populations requires additional measurements beyond factors typically considered by behavioral health providers, according to Erikka Taylor, chief medical officer of virtual eating disorder provider Arise.
Virtual eating disorder treatment provider Arise provides inclusive care utilizing a care team composed of a care advocate with lived experience, a therapist and a dietitian. The care model targets people who have been underserved by the eating disorder industry. It also includes online group support.
The provider prices its memberships at $99 per month, not including co-pays, and $49 per month for Medicaid beneficiaries, and accepts major insurance networks, including Cigna, Aetna, Optum and BlueCross BlueShield.
The company raised roughly $6.5 million in February. The provider landed $4 million in capital less than two years prior.
Providers often use the generalized anxiety disorder assessment (GAD-7), the patient health questionnaire (PHQ-9) and the eating disorder examination questionnaire (EDE-Q) to measure behavioral health conditions including anxiety, depression and eating disorders.
“The challenge with outcome measures is that sometimes we’re not necessarily measuring the appropriate things that we’re seeing in a population being served,” Taylor said. “How do we know the outcome measures have been validated in the communities that we are trying to reach? Because of that, we collect a lot of different data.”
To ensure a holistic understanding of its patients, Arise measures the World Health Organization (WHO) disability assessment schedule, and both ReKlame and Arise track social determinants of health.
Not tracking social determinants of health, such as access to transportation, food insecurity and housing status, would be to “treat patients in a vacuum,” Taylor said.
Intensive data collection is also key for providers looking to transition from a traditional fee-for-service model to more value-based care models, according to Rochaste.
“From day number one, start tracking metrics,” Rochaste said. “Even if you start in a fee-for-service, identify those [key performance indicators] (KPIs) that you believe are driving value, either for your patients or the insurer, and then align against those KPIs. … A lot of this is how much fiscal backing a company has to be able to take on more risks. So the best thing to do is to start showing value and start tracking data right away.”
Providers seeking value-based reimbursement models should also ensure that care, business and operational models are all aligned, Rochaste said.
More intensive systems of measurement do come along with higher costs for providers, according to Rochaste. But measuring KPIs allows ReKlame to demonstrate the overall cost savings of its services, which help prevent costly emergency room visits and inpatient stays.
The chronic nature of many behavioral health conditions, which can often lead to relapses, requires providers to develop KPIs that incentivize realistic results.
However, failing to align with payers on patient goals and incentives properly can be a pitfall during reimbursement negotiations.
“Part of the challenge that I’ve faced is, because eating disorders cross the boundary of being both medical conditions in psychiatric conditions, you’re talking to one section of the payer system about PHQ-9s and GAD-7s, but then missing some of the medical outcomes,” Taylor said. “It’s hard to have that integration and collaboration so that we can all be in agreement and alignment in terms of what those goals are and what those outcome measures look like.”
Other behavioral health providers have zeroed in on specific underserved populations, and have reeled in significant funding dollars.
Tech-enable care provider Folx focuses on LGBTQIA+ populations, offering virtual talk therapy and medication. The provider added its mental and behavioral health services in 2022 following a $30 million Series B funding round.
Digital mental health platform Anise Health provides tailored, culturally responsive care for Asian Americans. The provider raised $1.2 million in pre-seed funds in 2023 and recently expanded into Massachusetts, Florida and Washington, bringing the number of states in which it operates to six.
