As the healthcare landscape continues to evolve, payers are increasingly focused on Behavioral Health Integration in Value-Based Care (VBC) models. The push for innovation in healthcare contracting is growing rapidly, and one area where payers are keen to integrate services is in primary care settings. However, this integration is not without its challenges. Primary care providers (PCPs) often face significant barriers in adopting a fully integrated model, particularly when it comes to the use of data and creating the necessary incentives to support behavioral health alongside physical health.
As payers navigate these challenges, some are finding success in addressing the data gaps that have traditionally hampered Behavioral Health Integration in Value-Based Care. By providing primary care providers with better access to relevant and actionable data, payers hope to drive better health outcomes and improve the patient experience. With the rise of value-based care arrangements, which reward healthcare providers for improving patient outcomes rather than the volume of services delivered, integrating behavioral health into these models has become a strategic priority.
The Role of Data in Behavioral Health Integration in Value-Based Care
Samantha Chafin, senior director of behavioral health strategy and operational integration at Florida Blue, discussed the importance of data in enabling Behavioral Health Integration in Value-Based Care during a panel at Behavioral Health Tech 2023. “Integrated primary care—we’ve all heard that phrase, but what does that really mean?” Chafin asked. “It comes down to how we are helping and empowering primary care providers with actionable data.”
Florida Blue, a major health plan serving more than 5.9 million Floridians, has placed significant emphasis on making data available to primary care providers to enable better care coordination and integration of services. According to Chafin, Florida Blue has been equipping its providers with tools such as a provider portal and reporting systems that allow them to track both physical and behavioral health outcomes. By focusing on integrating behavioral health metrics into value-based care models, Florida Blue has ensured that all of its primary care value-based arrangements include at least one behavioral health quality metric.
Chafin further explained that empowering providers with actionable data allows them to deliver more personalized and effective care. “We have been empowering our primary care providers with data through our provider portal and reporting that really embraces both the physical and behavioral health results and outcomes,” she said. This integration ensures that health plans are not only focusing on the physical health needs of patients but are also holding providers accountable for addressing behavioral health conditions in Behavioral Health Integration in Value-Based Care models.
Expanding Behavioral Health Integration in Value-Based Care Beyond Primary Care: Behavioral Health in Specialty Care
While the primary care sector has been the focal point of much of the value-based care integration conversation, there is significant potential for innovation in specialty care as well. Florida Blue has recognized this and is working to expand Behavioral Health Integration in Value-Based Care beyond just primary care. Chafin highlighted how oncology, in particular, played a pivotal role in bringing attention to the need for behavioral health integration in specialized care settings. “It was actually oncology bundled payments that really first brought to the forefront the idea of having a behavioral specialist in their practice,” she said. “They knew the importance of addressing mental wellbeing for those individuals who are in cancer treatment.”
The integration of behavioral health specialists into oncology practices shows the importance of addressing mental health challenges for patients undergoing cancer treatment, who often face high levels of anxiety, depression, and other mental health struggles. This model of integrating behavioral health support into specialty care is not limited to oncology. Florida Blue is now working to integrate behavioral health services into other specialty areas, including OB-GYN and pediatric care.
Chafin’s comments reflect a growing recognition of the need for a more comprehensive approach to patient care, one that takes into account both physical and mental health needs. By incorporating behavioral health specialists into specialties like OB-GYN and pediatrics, Florida Blue aims to offer more holistic care that can improve patient outcomes across a range of health conditions, further advancing Behavioral Health Integration in Value-Based Care.
Leveraging Technology and Data to Identify Behavioral Health Needs
One of the challenges that payers and providers face when integrating behavioral health into value-based care models is identifying which patients need behavioral health support. Patients often experience behavioral health challenges that go unrecognized or untreated, and without proper identification, these individuals may not receive the care they need. To address this, health plans are increasingly leveraging technology and data analytics to identify patients who may benefit from behavioral health services.
SCAN Health Plan, which provides Medicare coverage to seniors in California, Arizona, and Nevada, has partnered with Lucet, a digital behavioral health company, to better identify members who require behavioral health support. Wendy Zhao, associate general manager at SCAN Health Plan, explained that by reviewing a member’s medical and pharmacy claims, as well as their responses to an annual health risk assessment, SCAN can proactively identify individuals who may be in need of behavioral health services.
“When we see a member who hasn’t had behavioral health service or an appointment with Lucet yet but has a medical diagnosis for a behavioral health condition or is on medication for a behavioral health need… we can proactively identify that member,” Zhao said. This partnership allows SCAN Health Plan to not only pinpoint members who may need support but also give healthcare providers a referral option to help connect these patients with appropriate care. By incorporating this data into the overall Behavioral Health Integration in Value-Based Care framework, payers and providers can ensure that patients receive the care they need when they need it.
The technology partnership between SCAN and Lucet also provides patients with more choices regarding the type of behavioral health providers they wish to see. This increased flexibility allows patients to share their preferences for specific types of therapists or providers, which helps SCAN Health Plan refine its network and better meet the needs of its members.
“We can be smarter about how we design the network,” Zhao explained. “We’re not just going out and saying, okay, we’re just going to meet the CMS network adequacy minimum and get the psychiatrist in this county to meet the requirement.” This data-driven approach enables SCAN Health Plan to design a behavioral health network that is more tailored to the needs of its members, ensuring better access to care for individuals across its service areas, and promoting a more effective Behavioral Health Integration in Value-Based Care model.
Overcoming Provider Resistance: The Need for Education and Support
Despite the benefits of integrating behavioral health into primary and specialty care, getting provider buy-in can be a significant challenge. Providers may be hesitant to adopt new technologies, especially if they perceive them as costly or disruptive to their practice. To overcome these barriers, payers must find ways to introduce technology solutions that are cost-effective and provide tangible benefits to providers.
Chafin highlighted the importance of offering technology solutions that not only help providers integrate behavioral health into their practice but also improve their revenue and profitability. “We needed to look for ways to bring technology to our provider partners that wasn’t going to cost extra,” she said. “Better yet, [the technology] optimizes their practice and improves their revenue and profitability.”
For example, in the case of SCAN Health Plan and Lucet, the technology partnership aims to make it easier for providers to refer patients to behavioral health services without incurring additional costs. By offering secure email, phone, or portal-based referral options, SCAN and Lucet aim to remove roadblocks that might otherwise discourage providers from referring their patients to necessary behavioral health care.
“It’s on us at SCAN and Lucet to really integrate our programs with the medical groups and the PCPs,” Zhao said. “Let’s make it easy for our providers to remove the roadblocks and the bottlenecks.” By streamlining the referral process and ensuring that providers understand how to use these tools, payers can help ensure that Behavioral Health Integration in Value-Based Care becomes a seamless part of patient care.
Conclusion
As healthcare continues to shift toward value-based care, the integration of behavioral health services into both primary and specialty care is becoming increasingly important. While challenges remain, particularly in terms of data sharing, provider buy-in, and technology adoption, there are clear steps that payers and providers can take to make this integration a reality. By leveraging data and technology to identify patients in need, incorporating behavioral health metrics into value-based care contracts, and offering providers the tools and support they need to succeed, payers can help create a more comprehensive and effective healthcare system. With ongoing collaboration and innovation, the integration of behavioral health into Behavioral Health Integration in Value-Based Care models has the potential to improve patient outcomes, enhance provider satisfaction, and ultimately create a more holistic approach to healthcare delivery.
