Basing payment on clinical outcomes rather than the volume of service is increasingly common among medical practitioners, yet value-based reimbursement is less common among mental health practices. In a new paper, Has Value-Based Reimbursement Arrived for Behavioral Health? A Payer Perspective, five experts from The Cigna Group outline the advantages and challenges of making value-based reimbursement arrangements the norm for behavioral health.
“The psychiatric profession has experienced several paradigm-shifting breakthroughs in recent decades,” said study co-author Dr. Stuart Lustig, national medical executive for behavioral health strategy and product design, The Cigna Group. “We believe the next frontier in behavioral health is value-based reimbursement, which aligns reimbursement with presumably better care of individuals and populations at a time of increasing scrutiny on cost, quality, and outcomes.”
Challenges to value-based reimbursement
Value-based care reimbursements incentivize better care by rewarding outcomes such as reduced time to care, improved clinical scores, patient quality of life, and reduced emergency room utilization. However, this reliance of data creates a significant hurdle in mental health practices because only 20% use measurements in their practices.
A technology gap is another issue: Mental health providers are slower than hospitals to adopt electronic health record systems.
Another challenge is the shortage of mental health practitioners in payer networks. Unlike physicians in other specialties, many psychiatrists operate cash-only practices. Just 55.3% of psychiatrists accept private fee-for-service insurance, compared with 88.7% of those who practice in other areas of medicine. Payers have been hesitant to drive value-based reimbursement due to the need to maintain robust networks for their members amidst nationwide shortages of psychiatrists.
Promising signs for implementing value-based reimbursement
Implementing value-based reimbursements in behavioral health shows promising signs, and stakeholder support is increasing. Key organizations and policy advocates endorse measurement-based practices, enhancing care quality and reimbursement opportunities.
Overall, there is growing consensus on the importance of measuring quality in behavioral health care. Studies indicate better outcomes, higher remission rates, and improved medication adherence when care is measured and focused on outcomes. Larger entities have greater capabilities due to their consolidated inpatient and outpatient facilities. This consolidation allows for uniform electronic medical records and better data aggregation.
Additionally, there is a willingness among payers to incentivize process and outcome measures, recognizing that achieving and marketing better outcomes is beneficial for business.
How measurement-based care improves outcomes and efficiency
Outcomes are better and achieved more quickly when practitioners measure care and design treatments to obtain specific goals.
“Ultimately, we believe that an increasing number of practices and facilities will have an increasing number of patients in value-based reimbursement arrangements, dependent upon candid conversations about how incentives will be paid,” the authors wrote, adding that the willingness of providers to work with payers leaves them optimistic about the future of value-based reimbursement in behavioral health care.
Evernorth’s commitment to advancing value-based care
Evernorth launched a measurement-based care program in 2023 with the goal of enhancing patient outcomes through aligning with providers on meaningful, standardized metrics for behavioral health care.
“Today, more than 53,000 providers are participating in our measurement-based care program,” said study co-author Dr. Doug Nemecek, chief medical officer, Evernorth Behavioral Health. “Our ongoing strategy involves building collaborations with key providers committed to quality outcomes and creating, with their partnership, interventions that will benefit patients, clients, and mental health professionals alike.”
This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Evernorth’s editorial team and subject matter experts.
