Thread by @RahulRajkumar11

Behavioral health (BH) care is in crisis – but payers have the opportunity to shape a better future. Payment reform can create a #BH system that is flexible and responsive, especially during times like now. THREAD @Health_Affairs @HobbsKnutsonMD healthaffairs.org/do/10.1377/hbl…

The crisis:
⬆️Rising suicide rates
⬆️Increases in drug overdose deaths
⬇️Substantially lower life expectancy among people with serious mental illness

One major problem: Access to #BH care is limited.
1⃣There’s a shortage of #BH providers.
2⃣Many #BH providers don’t join insurance networks due to low reimbursement.
3⃣Evidence-based #BH treatments exist, but not enough providers deliver these interventions with fidelity.

Less than 50% of Americans with #BH disorders access care. And when they do, the quality of the treatment may be questionable. samhsa.gov/data/sites/def…

Our long-term strategy is focused on improving #BH access, quality and efficiency. Our 5-step approach is:
1⃣Eliminating our carve-out
2⃣Integrating care
3⃣Increasing payment through value-based reimbursement
4⃣Deploying point solutions at scale
5⃣Measuring impact

Eliminating our carve-out: Many payers contract with managed #BH care organizations effectively “carving out” management and reimbursement for #BH services so they are separate from physical health.

This legacy structure is the OPPOSITE of offering whole person health. The carve-out causes fragmented delivery and perverse incentives to reduce the use of mental health and substance use disorder services.

To remove the carve-out, @BlueCrossNC simply added #BH to its existing functions. All #BH staff directly report through the same management structures as physical health. Case managers, nurses and physicians on our team now review physical and #BH cases together.

Removal of third-party vendors = streamlined ability to implement changes for members and providers. E.g., in response to #COVID19, we were able to change our policies to increase access to #BH care (including telehealth!) in line with our #COVID19 strategy for physical health.

Integrating care: We aim for 90% of our network primary care practices to deliver integrated care by 2022. Integrated care is THE workforce multiplier for #BH.

A broader population can access #BH care by how we proactively enable primary care providers (PCP) to delivery first-line #BH treatment @quartethealth

Value-Based Payment in #BH: To drive efficiency and align with our overall transition to value, we are tying increased reimbursement for #BH providers to improved access, quality and totally health care costs. Performance is rewarded through two different value-based contracts:

1 - Basic pay for performance: This model is upside only, limiting financial risk for smaller practices. Based on performance, #BH providers can earn an additional 10% of their annual reimbursement.

2 - Advanced payment model where we share accountability with providers for #BH quality and total cost of care: This reimbursement model is designed for larger multidisciplinary practices that address a variety of #BH disorders.

Rapid scaling of point solutions: Substance use disorders (SUD) are major drivers of poor health and high cost in @BlueCrossNC membership. For our commercial members with #SUDs, total health care costs are 3-5x higher than the general population.

To @BlueCrossNC, high medical expenses suggested an inadequate supply of providers in more cost-effective outpatient and community-based settings. That’s why we helped launch @EleanorHealth, a comprehensive provider of outpatient #SUD treatment.

This model involves in-person and virtual care and the delivery of medication and therapy to address opioid and other #SUDs, as well as co-occurring mental health conditions such as depression and the effects of trauma. @EleanorHealth aims to grow to 10 clinics in #NC by EOY.

Measuring Impact: @BlueCrossNC is measuring the impact of these interventions both in isolation and collectively across our membership, using a quasi-experimental approach. To start, we’re measuring changes in #BH service use.

We’re expecting increases in outpatient services and reduction in avoidable use of emergency departments and inpatient units by 2021. Prior to #COVID19, based on national estimates, we anticipated a 152% return on #BH investments through medical expense savings.

We’re in our second year of this long-term strategy to drive improvements in #BH access, quality and efficiency. This is only the beginning. @BlueCrossNC @quartethealth, @EleanorHealth, @HobbsKnutsonMD, @scottheiser, @azaleakim, @araopatel27

@sfoosness