The Covid-19 pandemic shone a light on the need for virtual behavioral health services. Yet, many patients have trouble accessing it, especially in New York, a study from Mental Health America found. More than 58% of adults with a mental illness in the state do not receive treatment, the report said. It ranked New York 42nd out of all 50 states for this measure.
Recognizing the need, Empire BlueCross BlueShield announced last week that it has selected four virtual mental health startups to add to its provider network.
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The companies are Alma, Headway, NOCD and Ophelia. The insurer chose to work with Alma and Headway because both companies’ software make it easier to expand in-network behavioral health providers that plan members can access, said Jordan Vidor, regional vice president of provider solutions at Empire. Meanwhile, NOCD and Ophelia address specific needs: obsessive-compulsive disorder and opioid use disorder, respectively.
Empire already works with companies in the virtual behavioral health field, including Talkiatry and Talkspace. But there was still more demand among members, leading the insurer to pursue additional contracts, Vidor said. Empire serves more than 4 million members and more than 38,000 business, union and small employers in New York.
“Access guided our decision to pursue these partnerships,” Vidor said. “If there are people who know they need care, but are having trouble getting care, that’s a problem. Addressing this is a big part of our mission to materially and measurably improve the health of all New Yorkers, and it’s driving our work to build our network out with innovative, new provider partners.”
Vidor hopes that at least some New Yorkers’ troubles may be addressed with each of these companies’ services.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Below is a description of the companies Empire is contracting with:
Alma (New York City): By working with major insurers, Alma simplifies the process for behavioral health providers to accept insurance. Clinicians who join the platform also have access to the company’s suite of tools, including scheduling, billing and HIPAA-compliant Zoom.
The company’s providers are now in-network for Empire’s commercial members. These members can search Alma’s online directory to find a provider that fits their schedule and mental health needs, and they can filter based on age, gender, specialty, race and ethnicity, sexual orientation, therapeutic style and specific concerns. After they find a provider, they can book a consultation right from Alma’s platform.
Headway (New York City): Headway helps individual behavioral health practitioners build their practice through its platform. The company’s software provides mental health providers with administrative tools like credentialing, scheduling, billing and revenue cycle management.
Commercial members of Empire can search for a provider on Headway’s website and select certain preferences, including race and ethnicity, language, LGBTQ+, geography, and in-person or virtual care. People see the price of care upfront and can book an appointment in as soon as 48 hours.
NOCD (Chicago): NOCD is a virtual provider for obsessive-compulsive disorder. The platform — now in-network for Empire’s commercial, Medicare and Medicaid members — allows people to receive virtual therapy from licensed therapists who specialize in Exposure and Response Prevention therapy.
NOCD also provides support between sessions, such as through peer communities and self-help tools.
Ophelia (New York City): Ophelia is a virtual opioid use disorder provider that pairs telemedicine with medication-assisted treatment. The company is now in-network for Empire’s commercial, Medicare and Medicaid members.
Through Ophelia’s website, members can schedule a consultation call to learn more about the program. Then, they have an initial video visit where they meet their care team, which consists of a prescribing clinician, a nurse and a care coordinator. The clinician reviews members’ medical histories and proposes a treatment plan. After that, members have remote follow-up visits, which can be done on a weekly, bi-weekly or monthly basis.
All four of the companies that Empire has selected leverage technology to either improve access or deliver better care.
“The pandemic has had a significant impact on our lives, particularly as it relates to mental health,” Vidor said. “That being said, one of the positives that came out of it was a greater openness to virtual care. Both patients and providers are more willing to engage in behavioral healthcare virtually, and we anticipate this trend will continue.”
Indeed, telemedicine visits have decreased for general healthcare services, but virtual mental health visits have remained steady.
Photo: SIphotography, Getty Images
