There are several barriers that make it difficult to shift away from fee-for-service payments in behavioral health, Dr. Lustig said. Among them are slower adoption of electronic medical records, a reluctance to measure outcomes and challenges bringing mental health providers into payer networks.
“All of that has been changing in recent years. More provider groups have gotten bigger, have gotten electronic medical records and have built in the ability to analyze those records and report out on what’s happening at an individual level and a population level,” he said.
Evernorth, Cigna’s health services arm, has 53,000 providers participating in a measurement-based care program for behavioral health.
In its value-based contracts, Cigna focuses on rewarding a few key outcomes, Dr. Lustig said, including how quickly providers can get patients in to receive care. The company also rewards providers for keeping patients engaged. Patients who visit the same behavioral health provider at least three times are likely to have lower medical costs, Dr. Lustig said.
One of the biggest barriers in the way of value-based care in behavioral health is data sharing. Cigna isn’t yet paying providers based on clinical outcomes, but hopes to be soon, Dr. Lustig said.
The company’s models are currently all based on upside risk — providers receive incentives for meeting better outcomes, but aren’t punished if they don’t hit their goals, Dr. Lustig said. In the coming years, more providers will be willing to take on higher risk, higher reward models.
“Some groups will be able to assume more risk, and the payouts will be bigger for greater results. I see the contracts getting more sophisticated over time, but right now, we are glad provider groups are working with us and willing to align on quality and affordability,” he said.
Even as models evolve, value-based contracts likely won’t be the right option for every behavioral health provider. “Mom and pop” or solo practices may not have the bandwidth for this type of model, Dr. Lustig said.
“Frankly, fee-for-service works fine, and there are lots of people who will pay their fees, even without insurance. Those aren’t the folks who will sign up for this first,” he said.
For providers who do want to jump into value-based contracts, “candid” conversations about the best metrics to track are key, Dr. Lustig said.
“I’ve come to the conclusion that providers are really excited about doing this as well. People want to get care that is more affordable and is better quality for all concerned,” he said.