Value-Based Mental Health May Be ‘Gold’ For Insurers
I write about health care and policies from the president’s hometown
Opinions expressed by Forbes Contributors are their own.
“The benefit in real healthcare reform is going to be in the mental health space,” Patrick Kennedy
“It’s not in our culture to think of about this whole-person health,” Kennedy says.
News that one of the nation’s largest health insurance companies is pursuing an evidence-based approach to substance abuse treatment and opioid addiction could potentially speed up the slow march away from fee-for-service mental health treatment.
But Cigna CI +1.68% and other health insurers that escalate their shift to value-based payments could reap a potential bonanza by reimbursing psychiatrists and other mental health providers based on how they improve the care of their patients, mental health advocates say.
Just ask Patrick Kennedy, who advocates for improving the nation’s mental healthcare system by moving to a value-based system, which measures and rewards providers based on how well they care for patients, treating them more holistically.
As a leading voice on mental health and addiction, the former congressman is pushing for quality measures for mental health treatment, which until last week hadn’t gotten attention from the nation’s largest health insurers. Mental health is often “carved out” by insurance companies despite most patients suffering from addiction and other mental health conditions also suffering physical conditions like diabetes, cardiovascular disease and cancer.
“The benefit in real healthcare reform is going to be in the mental health space,” Patrick Kennedy told more than 200 people at the University of Chicago Institute of Politics. “That’s where the gold is. It will be the way that insurance companies actually get the benefit of real healthcare reform.”
Through the Kennedy Forum, the son of the late Sen. Edward Kennedy and nephew of president John F. Kennedy is pushing the mental health industry to measure outcomes just like they are increasingly doing for physical illness in the medical care system. The Kennedy Forum last month issued its own report on how to “make measurement-based care a standard in behavioral health.”
“We don’t have any measures when it comes to behavioral health,” Kennedy said in an interview.
One model of care that insurance companies and the Medicare program under the Obama administration are pushing is via contracts with accountable care organizations. An ACO, an umbrella entity that links doctors and other providers, strives to improve quality and lower costs by better coordinating the medical care of the patients, making sure they take medications, getting more care upfront in a doctor’s office or clinic before patients get sick and have a bad outcome that can lead to an expensive hospitalization.
Currently, ACOs that achieve better outcomes and lower expenses divvy up the money saved with insurance companies. This works by doctors and hospitals taking on risk that they can keep patients healthy by improving quality of care for a population of patients.
Insurance giants like UnitedHealth Group UNH +1.02%, Anthem ANTM +1.28%, Aetna AET +1.43%, Humana HUM +0.80% and Blue Cross and Blue Shield plans contract with an increasing number of ACOs. But Kennedy said insurers typically “carve out” mental health treatment and sell it separately from medical benefits they offer to their customers.
“If you carve it out, it means you don’t see the benefit on the books,” Kennedy says.
But the “carve out” could be on the verge of changing as insurers recognize the potential benefit to their customers and their bottom lines. Just last week, Cigna, which is working to close its sale to Anthem, said it would develop a set of quality measures with the American Society of Addiction Medicine to come up with an evidence-based approach to substance abuse treatment that could lead to value-based payments rather than the fee-for-service model that is lacking.
Cigna said it will provide two years of medical claims data to the American Society of Addiction Medicine to “test and validate” what’s worked and what hasn’t when it comes to prescribing for disorders linked to substance abuse. Eventually, guidelines could be developed and used by Cigna and other health insurers to establish protocols for doctors and other mental health providers.
Many are hopeful but skeptical that the insurance industry will follow through on value-based models.
“It’s not in our culture to think of about this whole-person health,” Kennedy says. “But that is where the money is. The people who get their arms around it in the business world are going to be the people who make the biggest killing in terms of healthcare.”