Earlier this month Cigna subsidiary, Evernorth released a new analysis of the effect of behavioral health treatment on the total cost of care. The analysis compared pre-and post-treatment medical, behavioral, and pharmacy claims of over 275,000 individuals with commercial health insurance who were newly diagnosed with a behavioral health condition. When individuals received outpatient behavioral health services, costs decreased by $1,377 per person in the first year and $3,109 per person over two years. Savings were mainly a result of decreased emergency room visits and hospitalizations.
Savings began to accrue after only three to four outpatient behavioral health visits. The savings from receiving behavioral health care more than covered the cost of delivering the care and generated a positive return on investment (ROI). Evernorth’s analysis adds to a growing body of literature that recognizes that treating the whole person is the most effective way to ensure outcomes and decrease costs. For behavioral health providers, the analysis has three key takeaways. Providers must reduce stigma and increase access to behavioral health services. Once services are accessed, care must be engaging and effective. Finally, value-based payment arrangements will likely be focused on the total cost of care rather than siloed in physical or behavioral health.
Stigma is still a major issue in the behavioral health field. People are afraid to admit they need help for fear of how it may affect their relationships with their family, their standing at work, and how they are perceived. Behavioral health providers, health insurers, and trade groups must work together to spread the message that it is okay to not be okay. At the same time, behavioral health providers must ensure that people have a multitude of ways to access services where they are most comfortable. Access starts with the creation of a digital front door but also extends to more traditional ways of accessing services. Behavioral health providers should strive to create warm and inviting spaces while eliminating long wait times.
Once people have accessed services, services should be as engaging as possible to ensure that the course of treatment lasts long enough to be effective. As noted in the Evernorth analysis, savings begin to accrue at the 3-4 visit mark but decrease slightly as the number of behavioral health visits increases. Services that are engaging require a feedback loop that indicates whether services are resulting in an improvement. Clinicians require tools that tell them about changes in the client’s symptoms, whether the individual is improving, and their use of therapeutic tools with the client. If the client is not improving, clinicians should consider changes to treatment delivery. Care needs to be effective and result in better outcomes for the client.
Knowing whether clients are improving, is critical for behavioral health providers planning to enter into value-based arrangements. Providers are going to have to demonstrate to payers that care can be easily accessed and produces outcomes in a fairly short period of time for clients with mild to moderate conditions. Any value-based arrangement must consider physical health costs. As demonstrated in the Evernorth analysis, behavioral health services deliver savings on physical health but do not necessarily deliver savings on the behavioral health side. Value-based arrangements that focus on the total cost of care are going to deliver the most positive outcomes and savings for providers.
In the coming months and years, we are likely to see more studies and analyses that demonstrate physical health savings due to accessing behavioral health services. Behavioral health providers should strategize how to use these analyses to their favor and form key partnerships with payers, health systems, and primary care.