More than 1 in 5 American adults have a diagnosed behavioral health condition. They account for 41% of total health care spend. And a vast majority of these people struggle to connect with the care they need.
“When someone with a behavioral health condition decides they want to see a clinician, they spend countless hours searching only to find that many don’t have availability or take their insurance – and too many people end up having to wait weeks for an appointment,” said Amy Ayrault, President of Evernorth Behavioral Care Group.
Amy Ayrault, president of Evernorth Behavioral Care Group
That’s just one of the reasons Ayrault, a licensed clinical social worker who previously worked in community mental health, spearheaded the creation of Evernorth Behavioral Care Group, which offers patients quick access to quality in-network behavioral health therapy, where patients are guaranteed an appointment within 72 hours of scheduling. The group also enables participating behavioral health clinicians to work with payers with greater ease, efficiency, and collaboration.
“Our mission at Evernorth Behavioral Care Group is to simplify the care experience, so patients can focus on feeling better, and clinicians can focus on delivering best-in-class care,” said Ayrault, who was speaking at a special “campfire session” recently held at the National Council for Mental Wellbeing’s NatCon24 Conference in St. Louis, Missouri. In the session, Ayrault highlighted how behavioral health clinicians in Evernorth Behavioral Care Group can enhance their practice and their delivery of quality care.
Sustainable reimbursement and administrative efficiency
Ayrault said that some behavioral health clinicians choose to not participate in any health plan networks, and that the decision is primarily driven by apparent increases in administrative burden and, at times, unsustainable reimbursement for their care services. Evernorth Behavioral Care Group was created to solve those issues.
“Evernorth Behavioral Care Group offers clinicians sustainable reimbursement, including bi-weekly payments, late cancelation and no-show payments,” Ayrault said. “We also help with patient scheduling, payment processing, and other administrative work, so clinicians can focus on caring for patients.”
Ayrault also stated that Evernorth Health Services has assembled expert teams across its technology, product, operations, and care navigation staff to partner with clinicians on supporting patient care. One key aspect of that support is an easy-to-use online platform designed to handle patient onboarding, billing, and care logistics, as well as to make access to care easy for patients. “This online tool is especially helpful for smaller behavioral health practices that lack the infrastructure to offer online scheduling or an after-hours answering service,” Ayrault said.
Data-driven patient referrals
Ayrault noted that over 50% of people with behavioral health issues do not receive treatment, so Evernorth leverages its wealth of patient data to identify those in need of behavioral care. She cited an example of using claims analysis to identify Evernorth members who were prescribed a behavioral health medication but are not engaged in therapy. “A prescription is typically the first step to treating a behavioral health condition diagnosed by a primary care doctor, but it may not address all of a patient’s needs,” Ayrault said, adding that a combination of therapy with medication is typically a more effective treatment for behavioral health conditions than medication alone. To enable a more holistic care approach, Evernorth would conduct outreach to these medication-only patients and offer to connect them with an Evernorth Behavioral Care Group therapy appointment within 72 hours.
In addition, Evernorth’s data analysis of clinician information and patient insights help generate referrals that consistently align with the needs and preferences of both. “It helps ensure a greater patient-clinician match, which can lead to more effective and efficient care,” Ayrault said.
A means to measuring treatment progress and quality
Evernorth Behavioral Care Group participates in Evernorth’s innovative behavioral health measurement program, which tracks key metrics at each stage of a patient’s treatment, and shares insights with group clinicians. These metrics were developed by Evernorth in collaboration with its behavioral health network clinicians with the goal of improving the quality of patient care, and more metrics will be added over time as Evernorth and the clinicians continue to align on treatment measures.
“Through the advancement of measurement-based care, we provide timely insights that helps clinicians track patient progress, so they can quickly adjust their treatment plan as needed, as well as demonstrate their value by delivering positive outcomes,” Ayrault said.
Behavioral health clinicians who are interested in joining Evernorth Behavioral Care Group can apply at www.evernorth.com/behavioral-care/careers.
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.
