CMS Code Could Help Clear the Way for VR Cognitive Behavioral Therapy Reimbursement

The U.S. Centers for Medicare & Medicaid Services (CMS) has created a new code for virtual reality (VR) cognitive behavioral therapy (CBT) devices, including pre-programmed therapy software. The new Level II Healthcare Common Procedure Coding System (HCPCS) code could make it easier for Medicare payers to cover virtual reality in the future. While CMS has […]

New CMS Demo Could Help Incarcerated Individuals Get More SUD Care

The Centers for Medicare & Medicaid Services (CMS) is rolling out a new demonstration that could help expand access to substance use disorder (SUD) services by allowing state Medicaid plans to cover incarcerated individuals before release. Specifically, the demonstration allows state Medicaid programs to cover a package of pre-release services up to 90 days before […]

As UnitedHealth Group Looks to Deploy Capital on Provider Acquisitions, More Behavioral Health Deals Could Be Coming

UnitedHealth Group (NYSE: UNH) is doubling down on its value-based payment strategy and, in turn, further integrating behavioral health services. The company has ramped up its value-based care efforts in its insurance arm, UnitedHealthcare, and health services division, Optum. In UnitedHealth Group’s Q1 earnings call on Friday, it announced that Optum covers roughly 4 million […]

Ophelia, CareSource, Gateway: Investing in Community Can ‘Start Moving the Needle’ on SUD Treatment

Community support often falls outside of the addiction treatment-managed care fee-for-service paradigm. Payers and providers alike know the importance of fostering community in addiction treatment, and it’s a key to effective treatment and long-term recovery. However, developing communities fall far beyond their typical scope of services. Regardless, innovations around managed and value-based care seek to […]

58% of Humana’s MA Behavioral Health Claims Had a Value-Based Link

Health insurer Humana (NYSE: HUM) recently revealed that 58% of its 2.1 million Medicare Advantage (MA) behavioral health claims had a value-based link. In a report released earlier this month, the Louisville, Kentucky-based payer and health care provider noted that primary care doctors using a value-based model are more likely to see “physical and mental […]

How Quit Genius, Evry Health’s 100% At-Risk Deal Prioritizes Engagement and Clinical Outcomes

With thousands of digital point solutions on the market, payers and employers seek more out of their providers. As a result, digital behavioral health companies have gotten creative about contracting. Gone are the days of per member per month deals. Now, many point solutions offer engagement guarantees, cost-savings deals and at-risk contracting. Digital substance use […]

Highmark Health’s Behavioral Health Director: Personalized Care, Upstream Prevention Will Define the Industry

Highmark Health’s executive medical director of behavioral health, Bradley Karlin, is looking to tackle the increase in behavioral health needs by focusing on personalizing care and upstream prevention. He’s also looking to use more data to make decisions, he told Behavioral Health Business.  Karlin, who joined Highmark in January 2021, has a long history of […]

Digital Point Solutions Positioned for Value-Based Contracting, But Payers, EAPs and Providers Lack Consensus

Digital point solutions could have an advantage in the move toward value-based behavioral health care contracting. Tech-backed behavioral health providers have a leg up in collecting data to prove outcomes, and their virtual front-door approach could also lend itself to preventative behavioral health services. But for value-based contracting to take off in this space, payers, […]

Patrick Kennedy: It’s Time for a New National Behavioral Health Advocacy Movement

Congress created parity provisions for mental health coverage over a decade ago. However, critics say they lacked the necessary teeth to make payers fear the bite violating those laws. The road to true behavioral health parity will take buy-in from various stakeholders, including payers, providers, employers and advocates. In order to make this happen former […]