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How 3 Payer Execs Are Tackling Mental Health Services Integration, Reimbursement

Analysis  |  By Laura Beerman  
   August 16, 2023

Three Blues plan execs share mental health reimbursement strategies.

"We've passed legislation that says you must have mental health parity. That's going to sound so outrageous five or 10 years from now. Why was there ever not parity?"

This quote from the HealthLeaders’ Payer NOW Summit captures where mental health has been, but not where it's going. Just ask the trio of Blues plans executives that participated in the August summit panel: Mental Health: Can Healthcare’s Bridesmaid Lead Reimbursement, Coverage and Treatment Breakthroughs?

HealthLeaders: What has prevented mental health services integration, broadly and as an aspect of value-based care?

Gabriella Gold, CareFirst: We can't talk about mental health integration without first addressing access to care. Adequate and appropriate access to care will look different depending on the type of care the member needs.

Dr. Greg Harris, BCBS-MA: For about 10-plus years, we've had Alternative Quality Contracts that put our large medical groups at risk for mental health. That has helped but not enough. On top of that, we're building a specific model for psychiatric collaborative care management that puts a care manager and a consulting psychiatrist into the primary care setting. There's a coding structure now for this model of care, for reimbursement and incentives, and a big evidence base.

Dr. Tim Law, Highmark: Another part of value-based care is how you attribute a patient to a mental health care expert. Not everyone who provides mental health support submits claims, including some licensed professionals as well as loved ones.

Right now, we chase our tails in this industry trying to fill gaps. If we built the house correctly, there shouldn't be gaps to begin with. And we can't say that once we've filled the gaps, that we've redesigned the system or transformed utilization management.

HealthLeaders: How is your health plan expanding and rethinking access to behavioral health care and what unique solutions you are getting results from?

Gold: Our networks need to be all inclusive. Until very recently, we ran separate networks with distinct populations of providers who served the same membership but with different benefit designs.

The next step is ensuring that access maps to a continuum of care. An example of a technology we've rolled out to all our commercial members is an asynchronous chat function that mimics a coffee conversation with a close friend or family member.

We've also partnered with an organization to bring all of our solo practitioners together and incentivize technology use for charting and appointment scheduling. We're now seeing streamlined appointment bookings in under four days whereas previously, members were calling five to 10 providers and not getting a call back for 30 days. We've seen great strides there.

Dr. Greg Harris: It's great to hear what's going on in different regions, because that's another aspect of the silo.

About 50% of our network is solo practitioners so there's huge friction for our members in trying to figure out who's really accessible. Every interaction becomes very critical very quickly, so we've added three areas of focus: 1) primary mental health groups, 2) sub-specialty groups, and 3) navigation with three layers of customer service. A key element of the navigation is a QR code with a survey at the digital front door that allows members to directly access promoted groups. There is also a mental health advocate and a case manager, so there is this pathway.

One of our network innovations is to reimburse groups on a bundle based on access and outcome metrics. Most groups have agreed to two-day and five-day access standards and data reporting.

Dr. Tim Law: I wish we got together like this more often and talked about what programs are doing in different regions. There's no sense reinventing the wheel, right?

There is an unfortunate stigma attached to a mental health visit, so we've started to rethink the options. Our medical directors review mental health cases and we've started reaching out to physicians proactively on residential and inpatient hospitalizations that we might have previously denied. It has helped create such a collegial attitude between the payer side and the provider side. In the intensive outpatient therapy realm, we've also found ways for our smaller, self-funded, administrative-only accounts to buy up on programs that lead to better health outcomes.

HealthLeaders: What impact has digital health had (including consumer-driven tools) on mental health reimbursement strategies?

Gold: We expect our providers to update us on their practice regularly and to be accessible to members via online and in-person platforms. We need to be able to pay for one-click solutions like that.

Dr. Law: Highmark was the first payer in the country to cover prescription digital therapeutics, and we gained a lot of backlash and kudos. Once we vet something scientifically, we then send it to reimbursement to have them assess the company. We don’t want a scenario where, three months after a member starts using a digital health product, we yank the rug out from under them because the underlying business model was so poor that the company no longer exists.

Dr. Harris: There are apps that are consumer focused, there are digital therapeutics, there are technologies that support providers. As a strategy, we structure and prioritize solutions that center on a service as opposed to something that's more ancillary.

Next week, HealthLeaders will spotlight its second panel from the August Payer NOW Summit: Preventive Health: Coverage and Reimbursement on the Chopping Block?


“We've passed legislation that says you must have mental health parity. That's going to sound so outrageous five or 10 years from now. Why was there ever not parity?”

Laura Beerman is a contributing writer for HealthLeaders.


While mental health access, treatment integration, and provider coordination remain a challenge, these are the very areas were innovation is happening.

Executives from BlueCross Blue Shield of Massachusetts, CareFirst BlueCross BlueShield, and Highmark shared their plan innovations at a recent HealthLeaders’ Payer NOW Summit.

Their strategies range from patient attribution and provider network integration to access-boosting tech tools and strategy that spans the care continuum.

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