Despite growing payer interest in digital behavioral health services, industry insiders agree significant challenges still need to be addressed in insurers’ virtual care contracting strategies.

While traditional virtual mental health care has gained in popularity, there are still many services that digital behavioral health companies offer that aren’t covered by the government or traditional payers. Still, these payer and provider relationships are evolving and advocacy could be key to expansion in the future.

“We are not seeing CMS and others pay for the array of services that we can deliver. When I think about the [intellectual and developmental disability] side of behavioral health, remote support and different available offerings can’t be paid for,” Stacy DiStefano, CEO of Consulting for Human Services, said at Behavioral Health Business’ INVEST event. “So that’s on the backs of the providers who already have a woefully thin margin and that service line to deliver.”

CFHS is a behavioral health-focused consulting firm that works with nonprofit provider organizations, payers, state systems, tech vendors, and private equity firms.

But it’s not just government payers catching up with new service line coverage. It can be challenging to get wrap-around behavioral health services covered by commercial payers as well.

“Even on the commercial side, there are many things that would benefit the folks that we support that just aren’t reimbursed right now, unless you have, like a CCBHC model, or if you have a [per-member-per-month model], or there’s something where, basically, as the provider, you’ve got to figure out a way to make that work,” DiStefano said. “So I wouldn’t call that evolved at all. I think we have a very long way to go.”

In addition to one-on-one care, behavioral health tools, such as digital therapeutics, have faced an uphill battle in landing payer reimbursement. Leaders in the space, including Pear Therapeutics and Akili Interactive, faced significant reimbursement challenges and, as a result, struggled on the public market. Both Pear and Akili’s technology have since been acquired and are no longer publicly traded.

“If you think of digital therapeutics, it’s a fascinating space in digital behavioral health, and so many great new tools are coming to the forefront with incredible outcomes. They’re so inexpensive, and they help people behave better, if you will, and be better patients and take care of their health on a more regular daily basis,” Erin Boyd, chief growth officer at Talkspace, said at INVEST.

“But it’s so hard to get things like that covered. Sometimes it’s easier to get those covered by the government if you go down an FDA clearance route versus a commercial book, and having worked on a commercial plan, I know how hard it is to get these things covered.”

New York City-based mental health provider Talkspace is a publicly traded virtual health provider. It offers telehealth, asynchronous mental health services, and behavioral health coaching.

One way to help remedy these reimbursement challenges is through advocacy, but until then it’s on providers, and in some cases even patients, to fund non-covered services and tools.

“I think it’s going to be us advocating as an industry, and also patients advocating for themselves,” Arpan Parikh, chief medical officer at SOL Mental Health, said at INVEST. “But today, when you see groups, organizations and companies deploy these technologies or tools, they’re doing it, not knowing what their reimbursement is going to be, but because it’s the right thing for patients. At SOL Mental Health, we invest in these technologies. We deploy care that we’re not getting paid for on an incremental basis, but we know it will improve patient outcomes. … In an ideal world we should all be recognized for the effort and time and investment that goes into those.”

SOL Mental Health is an outpatient mental health provider. It offers adolescent and adult care in in-person and virtual care settings.

While there is still a long way to go in coverage, there are some bright spots for digital providers. For starters, many payers prefer digital providers because of their ease of access and cost-effectiveness. These issues are increasingly important as payers see a huge uptick in behavioral health service utilization from their members.

Still, at the end of the day, the member’s demand is going to be the most crucial.

“[Payer’s] job is to optimize the [medical loss ratio], and there’s no doubt that virtual care can be delivered in a much more cost-effective way than in-person care; ultimately, it’s going to be about number one, clinical outcomes,” Parikh said. “Is there enough proof that in-person care doesn’t deliver a clinically significantly better patient outcome? And number two, patients have to vote with their feet.”