Value-based, collaborative care models needed to expand access to mental health

Kristin Karaoglu · June 10, 2021 · Short URL: https://vator.tv/n/527a
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Executives from Optum, Cigna, Octave Health and PsychHub weigh in

The first breakout session of the Future of Mental and Behavioral event on June 9 focused on innovative care models in mental health.

Innovative Care Models in Mental Health Despite a great need, most people still don't have coverage for mental health. How are insurance companies and startups working together to give people the help they need? Moderators: Dr. Archana Dubey (Global Medical Director, HP), Bambi Francisco Roizen (Founder and CEO, Vator) Speakers: Kate Knutson (CEO at Optum Behavioral Care), Eva Borden (President, Behavioral Health at Cigna's Evernorth), Sandeep Acharya (CEO & Co-Founder, Octave), Marjorie Morrison (CEO, PsychHub).

Here are some takeaways:

-- How to attract therapists and mental health providers? Octave Health negotiates rates with insurance companies to enable it to offer therapists competitive rates, plus it deals with the administration paperwork. Cigna wants to make it easier for the provider to get matched to the right patient. In order to do that the matching requires several components. Firstly, there needs to be a diversity of providers (gender, ethnicity, etc.) to match patients; Secondly, there needs to be measurement-based tools to evaluate the quality of care to help providers work at their highest level. Optum wants to optimize telehealth and technology as well as a varied workforce to extend the care team in order to match the need with the right resources.

-- The fee-for-service model around paying for providers has to change. Optum's Kate believes the fee-for-service model breaks down when it comes to mental and behavioral health. Good mental health requires a team and collaboration amongst coaches, schools, families and providers. We need to get to population-based payments [a form of value-based care payment model] and measurement-based care in order to get differentiated outcomes that then can lead to differentiated payments. Right now, in a fee-for-service world, when providers call patients in between sessions to get updates, those "micro touches" are not funded. If a provider goes to a patient's school to advocate for the child, that micro touch is not funded. The models need to be created to accommodate these micro-touches. Payers have to update their claims systems and the industry as a whole has to do a better job correlating outcomes with payments. 

-- How is care being measured? Sandeep noted that only two in 10 providers do measurement-based care; They're just not trained to track care in this manner. Kate from Optum said that the most robust measures are symptom checklists, such as the standard PHQ-9 and GAD-7; These are useful but hard to collect; It's hard for patients to fill these out routinely; have them recorded in the aggregate and send them to payers; Most providers don't have EHRs to collect these surveys; We need to move beyond surveys to more objective-based measures that capture sleep, anxiety and mood trackers. Cigna's Eva says for low-acuity and sub-clinical patients that use behavioral health tools [e.g. Happify Health], she looks at the entirety of a person's health experience via medical, Pharma claims to understand whether behavioral treatments that are preventative are having an impact.

-- Therapists need to become more precise: Marjorie sees therapists moving away from being generalists and more toward being specialists because the way to treat insomnia is different from the way to treat substance abuse; Precision matching can work when therapists/providers are more precise about their treatment protocols. Cigna's Eva agrees: in order for therapists to get paid for the benefit they provide, there needs to be more precision around the service as well as the total spend of that patient, such as Pharma and medical spend.      

Future of Mental and Behavioral Health is brought to you by Vator and UCSF Health Hub. Thanks to our sponsors: AdvsrScrubbedStratpoint. As well as BetterHelp, go to  BetterHelp.com/Vator for 10% off BetterHelp. This podcast is also brought by Octave, your partner for mental health and emotional well-being. Learn more at FindOctave.com. Also thanks to NeuroFlow which is working with hundreds of healthcare organizations to provide best-in-class technology and services for the effective integration of behavioral health. Learn more at neuroflow.com). You may still register for our June 9 and July 14 events, which are part of the Future of Mental and Behavioral Health series. 

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Kristin Karaoglu

Woman of many skills: Database System Engineer; SplashX event producer; Author of Startup Teams

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Archana Dubey, MD

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Global Medical Director, Hewlett-Packard Enterprises
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Bambi Francisco Roizen

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Author of "Unequally Yoked"; Co-founder Vator and Invent Health; Former Columnist/correspondent Dow Jones MarketWatch; Business anchor CBS affiliate KPIX