Evernorth Contract Expands Payer Involvement in Online Addiction Treatment

"Our goal is to help people navigate to the right care; that’s where we are focused," says Evernorth behavioral health CMO Dr. Doug Nemecek.

Evernorth and Monument have launched a partnership for online alcohol treatment that both companies hope to expand post-pandemic. Monument’s contract with Evernorth, the health services division of Cigna, represents a significant expansion of its payer relationships in what had been a self-pay consumer service. In addition to improving affordability, access, and individual outcomes, virtual substance abuse provides multiple opportunities to address stigma, the mental health provider shortage, and to reimagine benefit and network design post-pandemic.

Monument’s program combines virtual peer and professional therapy with specialized treatment from licensed physicians and specialists, including medication support. Monument’s online platform broadens treatment options for people who might not otherwise be able to get into a treatment program or have access to one.

The payer piece

Increasing alcohol treatment access and affordability are primary goals for Evernorth and Monument, as well as other payers. Monument began offering coverage options at the end of 2021 and is in-network with more than 20 commercial payers and Medicare. This includes national payers such as Aetna and Optum/United Healthcare as well as large multi-state plans like Anthem, multiple Blue Cross Blue Shield plans, and local/regional players.

Monument coverage is available to all Evernorth behavioral health customers, including Cigna employer group and marketplace members in 20 states. In seven states—Iowa, Ohio, Maryland, Mississippi, South Carolina, Texas, Washington—Cigna is the only payer partner besides Medicare.

Speaking with HealthLeaders, Evernorth behavioral health CMO Dr. Doug Nemecek notes: "As we look at increasing needs, we want everyone who has a condition to have access to high-quality, evidence-based treatment. Our goal is to help people navigate to the right care; that’s where we are focused."

While Monument notes that its program is "price competitive with or without insurance," adding payers is a priority. In a recent press release, Monument CEO and co-founder Mike Russell stated: "Delivering on our vision requires increasing affordability and reach of effective treatment. Payers play a crucial role in that ..."

Monument’s plans range from no-cost support via therapist-led or community-driven groups to $249 per month, which adds unlimited physician appointments and therapist chat, weekly appointments, and medication options. Customers can send their insurance details directly to Monument for available coverage options and costs.

Significant need

Whether as a self-paid or covered service, online alcohol treatment may help address multiple challenges. The National Center for Drug Abuse Statistics has reported that 60% of people drank more in pandemic isolation. This occurred against a backdrop of newly limited in-person treatment options, ongoing stigma, and existing substance abuse provider shortages—until virtual options emerged and became popular.

Unlike other telehealth services, mental health utilization has remained high: increasing from 30% in January 2020 to a pandemic high of nearly 63% in October 2021. This according to FAIR Health, whose latest figures show usage at 55% (December 2021). Payers like Cigna remain committed to not only telehealth but virtual-first services and benefit designs, not only for routine needs but chronic conditions.

"In all the talk of how the pandemic has accelerated innovation,” says Nemecek, "it’s important to remember as it fades, that all of these mental health and substance abuse [MH/SUD] conditions are still there."

The stigma symptom and online treatment ethics

In many ways, virtual mental healthcare is a consumer-driven phenomenon. Self-downloaded free or subscription-based mobile apps have become part of a delivery system that looks less traditional every day. The benefit of apps, mental health virtual visits, and digitally based addiction treatment are reflected in Monument’s value proposition: "Online alcohol treatment on your terms."

Addressing stigma is one of the benefits. Evernorth’s Nemecek notes: "The stigma around substance abuse is still high. A solution like Monument could mean not having to be worried about taking time away from work, what people are thinking, and getting treatment sooner." While there is no guarantee that more accessible and affordable treatment will reduce stigma, more options and greater uptake can certainly help. And help is needed. In 2020, Mental Health America reported that while mental illness affects 20% of the U.S. adult population, fewer than half receive treat­ment.

There are also ethical issues surrounding digital mental health, particularly for serious and persistent illnesses. As online solutions grow, there is a corresponding call for "re­sponsible innovation for mental health care . . . to strengthen the positive role of nov­el technological solutions, and recognise and work to manage both the real and potential risks of using digital platforms."

These risks include privacy, and it is an irony that the greater confidentiality that online versus in-person treatment affords can be compromised if the data generated is not kept private and secure. In addition to these new considerations, progress on long-standing issues like coverage and reimbursement parity for mental health and telehealth must be made.

Progress measured by outcomes, not speed

COVID-19 is the best and worst thing that could have happened to MH/SUD prevalence and treatment—exacerbating existing need while generating the much-needed attention that helps create better solutions.

About the Monument solution, Nemecek notes: "Alcoholism is a chronic condition. We don't expect results in 30 days. We want to look at who engages, how many, and who stays engaged over months and or a year before we can assess outcome data."

The Evernorth executive adds: "It’s important to give support around alcohol use. Alcohol is the most common substance abuse. We don’t spend enough time on it because issues like opioids get more attention."