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Episode 18: ROC Monthly Mastermind Call
Cigna/Evernorth: Discussion Recap on the Future of Value-Based Care
Moving the Needle Forward, Together
An Open Discussion on the Future of Value-Based Care
Thank you to Dr. Stuart Lustig, Cigna/Evernorth’s National Medical Executive for Behavioral Health Provider Partnerships, for joining us this month!
We know that if we want to move the needle, we (the providers) must collaborate and find common ground with those involved in our shared goal. Together, we can have an open mind in the pursuit of an effective partnership and a better future for patients and families.
Read on to hear more about what was discussed, upcoming discussions to attend in order to keep the conversation going, and action items you can lean into now.
Reflecting on Where Cigna Is at with Value-Based Care
From network shortages to expanding treatment modalities, Cigna wants to be an ally.
Changes Cigna is Experiencing: As virtual treatment and aftercare programs have become effective healing methods, we’ve seen the rise of new treatment modalities. This exploration is essential for all as we strive for better; remember that analytics on successful treatment will continue to be imperative.
Value-Based Contracting: The majority of clinicians and private practices are not contracted; Cigna is experiencing shortages of providers in some regions of the country – both in the inpatient and outpatient settings. This is an opportunity for providers and payors to see where the demand can meet the needs.
Looking Forward with Hope
As Stuart shared from his experience and perspective, the behavioral health industry’s progression has many positive aspects.
Outcomes: They are getting better, thus raising the bar for quality treatment.
Mergers & Acquisitions: Facilities are vertically integrated with venture capital, improving data capture efficiencies. Join our August Masterminds Discussion to hear more on this!
Electronic Medical Records: It’s all about data, reporting, and outcomes. This is advancing the tracking and measurements for payors and providers to ask the right questions, forecast more effectively, and develop rating scales.
Membership Organizations: Facilities utilize third-party entities to help move the needle on value-based care and measurement-based treatment (JCAHO, NAATP, ROC, etc).
Different Paths, Same Goal
Whether you are a provider, payor, or patient – we all want to increase access to treatment and make it as affordable as possible for patients & families.
So, how does Cigna/Evernorth currently measure and define what good treatment is? Well, that’s where they admit – they need providers (the experts in behavioral health)
However, there are notable determining factors:
Process variables. Related to the timing of admissions, it is trackable but only sometimes accessible.
Proxy for a therapeutic alliance. After the initial intake, do they continue to show up for treatment? And if they do, are they actively engaged?
Discharge/follow-up post-treatment. This is often a vulnerable time for individuals; discharge looks different for everyone based on aftercare type, resources, outpatient therapist(s), etc. Cigna is curious, though – how quickly are these handoffs happening?
Data sharing. Operationalizing the exchange of data can be a challenge, but EMRs and other third-party-outcomes-focused organizations are helping progress that. Cigna admits the data has to be actionable, real-time, and easily transferred.
Measures of Good Quality Care = Better Outcomes
How do we define the difference between “success” and “value”? And once we determine that, how do we pay for it?
As we all know, delivering ‘better care’ in the behavioral health space can feel ambiguous. It’s not comparable to an orthopedic visit, getting surgery, followed by physical therapy, then being ready to play basketball again.
Patient outcomes are not just about abstinence; there’s a wide variety of factors like social functional measures (living situations, employment, school), and we should be able to show overall health trends. These quality-of-life changes show value, thus showing success for all parties involved.
So…where do we go from here?
Payors leave it up to providers to show what we define as success — since we are the experts – now, we just need to decide what we want to show and how.
September 2023: A Call to Action for ROC Members
It takes revenue-cycle providers, payors, and treatment providers to make a difference, and the conversation is just getting started.
Between all of us here at ROC, we can have the opportunity to pitch our ideas, concerns, and possible solutions to payors. We will keep moving this needle forward in our September Masterminds discussion. Stay tuned for details to come.
What You Can Do Now
What are you currently measuring?
What do you feel payors are currently expecting?
What would you remove?
What do you think should be measured more?
How do you feel we could standardize without re-inventing the wheel
Who is doing this well? Could you adopt their progress/process?
We will use our answers to these questions in our future Masterminds discussions!
Regarding Contracting Questions or Comments with Cigna/Evernorth:
Email email@example.com about what you are proposing for your facility regarding contracting.
Help them understand your business model, what is being proposed, and how you want Cigna to work with you.
Share how you determine health and success in your patients, thus, success in your treatment approach.
Share how you are currently tracking outcomes.
What to Expect Soon
Tuesday, August 8th: Masterminds meeting with Vasanta Pundarika, Head of Healthcare Investment Banking with Matrix Capital Markets Group, Inc.
Tuesday, September 12th: Masterminds meeting with outcomes leaders in behavioral health that will help put action into how to build better relationships with payors.
This is how we work together to make the future better - sharing ideas and information, all with a common goal. Make your voice known!