Evernorth, the health service division of Cigna, is playing a crucial role in shaping the future of integrated and measurement-based care in the behavioral health sector. As part of one of the country’s largest “payvider” organizations, Evernorth is strategically positioned to deliver innovative care models that bridge the gap between behavioral health and physical health care. With an emphasis on digital health partnerships and value-based care, Evernorth is redefining how care is delivered and how outcomes are measured, improving both patient experiences and health outcomes.
To dive deeper into these exciting developments, we sat down with Dr. Doug Nemecek, Chief Medical Officer of Behavioral Health at Evernorth, to explore the company’s approach to integrated care, its commitment to value-based care, and its innovative measurement-based care program.
The Importance of Integrated Care
Integrated care has become a key topic in healthcare discussions, particularly as the understanding grows that mental health and physical health are inextricably linked. For Evernorth, integrating behavioral health with physical health is not just a strategic priority; it’s a fundamental approach to providing holistic care that optimizes patient outcomes.
Dr. Nemecek shared, “You need both physical and emotional health if you want to reach your optimal potential.” He explained that patients, particularly those dealing with serious conditions like cancer, often experience overwhelming emotional distress in addition to their physical health challenges. For instance, a patient with breast cancer may struggle not only with the medical side of treatment but also with anxiety, stress, and logistical concerns about work and family.
Recognizing these emotional challenges is critical, as behavioral health support can significantly impact both the patient’s well-being and the medical outcomes. Dr. Nemecek highlighted research showing that oncology patients who received behavioral health support were less likely to have avoidable emergency room visits, ultimately saving significant healthcare costs.
Going Beyond Referrals: Ensuring Real Integration
When asked about how Evernorth is advancing integrated care, Dr. Nemecek emphasized that integration isn’t just about co-locating services or making referrals. It’s about ensuring that all healthcare providers—whether they’re physical health professionals, mental health professionals, or behavioral health specialists—are connected and working together as a team. This collaborative model ensures that patients receive the most comprehensive and effective care possible.
Dr. Nemecek also touched on the importance of data sharing across different domains of care, such as medical, pharmacy, and behavioral health. By leveraging this data, Evernorth can identify patients who may need behavioral health support before they explicitly ask for help. This proactive outreach can significantly improve patient outcomes by connecting individuals with care sooner and preventing more serious issues from developing.
Addressing the Rising Costs of Behavioral Health Care
Behavioral health conditions account for a significant portion of healthcare spending, with patients diagnosed with mental health conditions or substance use disorders often requiring extensive, ongoing care. Evernorth’s approach to addressing these rising costs is focused on providing timely, high-quality care that reduces the need for more expensive interventions later on.
According to research from Evernorth, patients who received behavioral outpatient care for conditions like anxiety or depression experienced a substantial reduction in total medical costs over time. In fact, patients who received this early intervention saw reductions of up to $2,500 per person within the first 15 months following a diagnosis. Over a longer period (47 months), the savings increased to $3,300 per person. These findings highlight the economic value of investing in early and effective behavioral health treatment.
Digital Health Partnerships and Innovation
As part of its comprehensive approach to behavioral health, Evernorth has prioritized digital health partnerships to expand access to care and improve patient outcomes. The company has formed strategic collaborations with innovative digital health providers like Bicycle Health, NOCD, and Pelago to offer digital support for substance use disorders, obsessive-compulsive disorder (OCD), and other behavioral health conditions.
Dr. Nemecek noted that Evernorth is always looking for new digital health partners who can offer innovative solutions to improve the way behavioral health care is delivered. He explained, “We have a structured governance process where we evaluate the strengths and value of these prospective digital companies, looking at our needs, our members’ needs, and our clients’ needs.”
Despite the many digital health providers emerging in the marketplace, Dr. Nemecek acknowledged that one of the main challenges is ensuring that people are aware of these resources and how to access them. This is why Evernorth is dedicating significant effort to educating members about the digital tools and services available to them, helping to bridge the gap between traditional and digital care.
The Opportunity for Innovation in Behavioral Health
The behavioral health system is notoriously complex and fragmented, making it difficult for patients to navigate their care options. Dr. Nemecek pointed out that there’s a tremendous opportunity for innovation, particularly in making behavioral health services more accessible, personalized, and efficient.
Evernorth is working on a number of initiatives aimed at simplifying the behavioral health journey for patients. This includes creating specialized programs for specific patient populations, such as the LGBTQ+ community, and leveraging digital resources to provide personalized care. Additionally, Dr. Nemecek emphasized the potential for automation to streamline aspects of the behavioral health system that are currently inefficient, ultimately improving both access to care and care delivery.
Evernorth’s Measurement-Based Care Program
Earlier this month, Evernorth announced the launch of its new behavioral health measurement-based care program. This innovative program aims to align on quality care metrics that drive improvements in care, cost, and collaboration while reducing administrative burdens for providers.
Dr. Nemecek explained that measurement-based care helps to create transparency in the care process, allowing both payers and providers to track patient outcomes and identify areas for improvement. By embedding shared metrics into the care process, the program ensures that everyone involved—whether it’s the patient, the provider, or the payer—has insight into the patient’s journey and the effectiveness of the care being delivered.
This program is particularly relevant as Evernorth continues to push forward with its value-based care initiatives. The company’s focus on measurement-based care allows for more meaningful conversations about value-based care contracts, where outcomes and cost savings are prioritized over volume-based metrics.
The Future of Value-Based Behavioral Health Care
Evernorth is on the cutting edge of value-based care in behavioral health, and Dr. Nemecek is optimistic about the future of this model. The company is actively working to evolve its contracting approach to include more value-based contracts, with a particular focus on behavioral health.
One exciting development on the horizon is the introduction of value-based care contracts that include behavioral health metrics for primary care physicians. This will help to ensure that the integration of behavioral and physical health care is incentivized across the entire healthcare system, leading to better outcomes for patients.
As Dr. Nemecek put it, “We’re excited about value-based care and increasing partnerships with providers.” The company is committed to driving meaningful change in the healthcare system by improving both the quality of care and the cost-effectiveness of care delivery.
Conclusion
Evernorth is at the forefront of reshaping the future of behavioral health care. Through its commitment to integrated care, value-based care, digital health partnerships, and innovative measurement-based care programs, Evernorth is leading the charge in creating a more holistic, efficient, and patient-centered behavioral health system. As the company continues to expand its efforts, it has the potential to significantly improve both patient outcomes and healthcare costs, while also paving the way for future innovations in the behavioral health space.
The integration of behavioral and physical health care is no longer a distant goal; it is becoming a reality, thanks in large part to organizations like Evernorth that are championing these advancements. With a focus on both patient care and operational efficiency, Evernorth is shaping the future of behavioral health in ways that will benefit both patients and healthcare providers alike.
