The healthcare industry is slowly moving away from fee-for-service care models and toward value-based care — but contracting in these arrangements remains especially difficult for behavioral health providers, according to Taft Parsons III, chief psychiatric officer at CVS Health/Aetna.
He highlighted this issue during a panel discussion on Tuesday at the Behavioral Health Tech conference in Phoenix. The panel focused on how payers approach value-based care in the behavioral health space.
Parsons — who is a psychiatrist by training — noted that his company owns Oak Street Health, a network of value-based primary care centers for adults on Medicare.
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“[Oak Street] takes on total global risk. We contract with lots of providers on the Aetna side that are large PCP practices taking on risk, and we’re also working within behavioral health to try to figure out what these value-based contracts look like when you’re just talking about specialty providers — and the the manner in which we work with those groups is is significantly different,” he explained.
Oak Street’s primary care providers take on pretty much all the risk in their contracts, Parsons said. These providers do so with the knowledge that they will be responsible for not just their patients’ physical health outcomes, but also their behavioral health outcomes, he added.
To better ensure success in these contracts, Oak Street has adopted a collaborative care model that integrates behavioral health services with primary care. The organization employs its own behavioral health teams who are trained to address patients’ social determinants of health — a collaborative model that makes it easier for primary care providers to manage their patients and ensure they receive holistic care, Parsons noted.
In Aetna’s broader provider network, things aren’t always so collaborative, he pointed out.
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“One of the things that becomes a complexity within our provider network is when we do not have a risk-taking PCP, and then we have a behavioral health provider who wants to take on some risk — it becomes difficult to figure out how to do that attribution. How do we administer that contract?” Parsons remarked.
In other value-based contracts, payers have figured out ways to give primary care providers attribution for things like improved diabetes outcomes, he noted.
“I have yet to meet a primary care provider that doesn’t want to take credit for outcomes in diabetes care. Yet, it doesn’t seem to matter that the only thing that was different was that they got the patient into behavioral health care,” Parsons explained.
In the payer world, there is an understanding that managing members with untreated behavioral health disorders is far more costly than providing them with appropriate care for these conditions, he noted.
Still, behavioral health providers often feel like they have to continually make their case to payers, Parsons pointed out. These providers have to repeatedly assure payers that behavioral care will end up decreasing the total cost of care in order to justify value-based contracting, he said.
“That’s not the bar that we make orthopedic surgeons jump over,” Parsons remarked. “When you look at other specialties, nobody tells the renal doctors that they can’t continue unless they can demonstrate that they’re actually reducing the total cost of care. [Payers] aren’t going to not let their members get dialysis.”
Parsons stated that this is “an inappropriate bar” to make behavioral health providers jump over, especially in the midst of a national mental health crisis.
Another panelist — Rachel Goldberg, vice president of strategic partnerships and product innovation at NovaWell, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey — expressed the view that behavioral health is an important part of members’ overall health and deserves to be integrated into their greater care plan through value-based care arrangements.
“Behavioral health is not the place to try to curb costs necessarily. It’s really important to get people the appropriate care they need,” she stated.
Editor’s note: This story was updated to include commentary from an additional panelist.
Editor’s note: This story is based on discussions at Behavioral Health Tech, a conference held this month in Phoenix. MedCity News reporters Katie Adams and Marissa Plescia were invited to attend and moderate sessions at the conference, and all their travel and related expenses were covered by Behavioral Health Tech. However, company officials had no input in editorial coverage.
Photo: Nuthawut Somsuk, Getty Images