Value-based care has been a buzzword in behavioral health for decades.
Still, it can be difficult for behavioral health providers to begin that journey and determine effective strategies versus unsuccessful approaches.
Veterans in the space say you’ll need three things to get going: technology, understanding the financial outcomes and solid partnerships.
“You have to understand value from your [provider] perspective, and you have to understand value from [the payer] perspective,” Aaron Simon, head of managed care at Geode Health, said at Behavioral Health Business’ VALUE event. “If you can’t express what your value is to [payers] and to the patients, you’re never going to win because they have two people who they’re trying to serve. … They’re trying to serve the patients and give them a good experience. They’re also trying to serve the employer groups paying their bills. So you have to be able to figure those two things out.”
Geode Health was founded in 2021 by the global investment firm KKR. The Chicago-based startup provides in-person and virtual outpatient treatment nationwide.
Technology support
While the behavioral world has historically lagged behind physical health in technology adoption, it’s an essential part of being able to capture the data that proves outcomes to payers.
Simon said electronic health records (EHRs) are the backbone of this data capture.
Yet behavioral health providers have been slow in EHR adoption, partly because they were left out of the 2009 HITECH Act, which gave health care providers funding to encourage the “meaningful use” of EHRs.
“You have to be able to prove that you are different from other providers, and the only way you could do that is by having technology or data built into your program that allows you to do that,” Simon said.
Simon noted that Geode technology is built into its DNA. It uses Athena Health-based EHR to collect data and has its own set of proprietary metrics used in contract negotiations to prove its clinical quality.
While data strategies are critical, it can’t just be collecting data for the sake of collecting data.
“How ready are you to ingest, analyze and report on data? That’s going to be super important, and [you need to] understand the value of those data points, right?” Dr. Diego Garza, senior vice president of strategy at Mindpath Health, said at VALUE. “Because capturing data for the sake of capturing is not really important. It is what you can do with that data, how you can inform patient outcomes through that data.”
Mindpath Health is the product of the merger of two outpatient mental health companies on each coast: Mindpath Care Centers, which was focused on the Southeast Coast, and Community Psychiatry, which was focused on California. The two companies merged in May 2021.
Understanding what payers want
Providers typically have a strong foundation in understanding clinical behavioral health outcomes. In order for value-based care arrangements to work, they need to be able to understand how those outcomes fit into the larger patient picture.
“Understand how your care delivery model impacts outcomes of your patient population,” Garza said. “The fact that we provide psychiatry and psychotherapy services doesn’t mean that the patients are actually getting better. What you’re measuring against that is very important. And the last piece, because this is a payer-driven conversation, is understanding the financial value your interventions bring and how this is productive care.”
Payers can bring a certain amount of claims data to the table, but still need help from providers to fill in the gaps.
“The empirical data that we have, the claims data, answers about 60% of the questions we need to answer [for value-based arrangements]. We’re not pulling in everything from your EHR system,” Andrew DiGiacomo, director of national network strategy and innovation and provider experience at Evernorth, said at VALUE. “We’re getting a lot of that stuff from the claims data, and that can get us about 60% to 70% there. What we’re starting to pilot, and what we’ve done with about 60,000 providers already, is going to these provider groups and starting to fill in the puzzle there and pulling in that additional data to combine it so then we can do some comparisons towards the general group of members and see, is there a cost difference? Are we getting a difference in the total cost of care there? And is it valuable?”
Evernorth is a health service division of Cigna’s (NYSE: CI). It offers a wide range of behavioral health and substance use disorder services.
Partnerships are everything
For negotiations to be fruitful and data exchange to happen successfully, there needs to be a level of trust and partnership between payers and providers.
“We have a good amount of the data, but if we want to really get into real measurement-based outcomes relationships, … we need to connect with provider groups and be able to ingest their data as well and make that combination. It’s not easy,” DiGiacomo said. “It’s also not cheap. For the most part, whether it’s things we need to set up within our teams and our approaches and then also asking those provider groups to give us that data right? Some of that is your data, and you don’t want to share it for nothing. I wouldn’t blame you, but that’s part of that partnership.”
Still, at the end of the day, partnerships mean more collaboration that could help patient outcomes.
“If you have the patient in mind, at the center of everything you do, you’re likely to be more successful in your approach,” Garza said.
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