In a world where behavioral health has been siloed for so long, is it really possible to find behavioral healthcare outside of point solutions? Is coordinated pharmacy, medical and behavioral care feasible? We spoke with Chief Growth Officer, Melissa Reilly, and Chief Medical Officer, Dr. Doug Nemecek, about Evernorth’s goal to make this utopia a reality.
By now, we all know that unaddressed behavioral health conditions can negatively impact co-occurring physical health conditions. But first, Melissa and Doug dive into the ramifications that affect payers. They will also touch on Evernorth’s approach and key considerations in behavioral healthcare.
Melissa: Over the last few years, there has been such an increased focus on mental health and behavioral health needs and payers that we work with have a unique spectrum of needs that is often based on their unique populations. Across that spectrum, we have seen firsthand, when members do not get the behavioral care they need – it increases the total cost of care and their members' ability to live the lives they want.
With the average delay between symptoms onset and treatment being 11 years, time to quality care has a huge impact on a payer’s total outcomes measures and also an individual’s ability to be a productive member of their community.
The other thing we tackle every day is that data across the care ecosystem is fragmented. Access to care is limited. Health equity and cultural concerns are often overlooked. Navigating behavioral health care without the right partner can lead to overspending. Members may start and stop care and/or switch providers a number of times before they find the right provider or the type of care that meets their unique needs. A first-of-its-kind analysis completed by Evernorth found that people diagnosed with a behavioral health condition, such as anxiety, depression, or substance use disorder, who receive behavioral outpatient care had lower total health care costs by up to $1,377 per person in the first year compared to those who didn’t. Not only that, the savings impact was sustainable over time with a two-year cost reduction of up to $3,109 per person.
Our behavioral health solutions support the reduction of overspending by addressing behavioral and mental conditions before they further complicate health. We also can help payers solve some of their biggest challenges by leveraging our suite of Evernorth assets. Our data and collaboration with our partners allow us to proactively identify and engage with members early before it leads to a bigger issue. By matching members to the right level of resources more quickly, our next-generation experience delivers data-driven, personalized care on demand. We partner with our clients and those we help every step of the way to guarantee results.
Doug: Unaddressed behavioral health conditions also play a large role in a person’s other medical comorbidities. Someone who is struggling with diabetes, for example, is significantly more likely to be struggling with depression. 92% of adults living with behavioral health disorders also suffer from physical conditions and cost approximately 3-6x more.
Our approach is focused on whole-person health, and it’s imperative to pay attention to both mind and body – that is where we see the most success.
Melissa: At Evernorth, elevating behavioral health means providing a set of services that help to stabilize and improve a person’s wellbeing (body, mind and spirit) along with creating awareness, positive coping skills and tools to build resiliency—reducing the burden of their issues, big or small. Enabling people to contribute productively and effectively to live their life with peace of mind.
We are always innovating and connecting cohesively across the ecosystem – we don’t wait for the call – we are proactive in identification, engagement, and network outreach tailored to a member’s needs- like providing quick access to care and looking at medication impacts, how and when our employees used it, with measurement to ensure your population is on the right pathway to optimal health. We elevate behavioral health through a data-driven approach that meets members where they are across the healthcare ecosystem, like when filling scripts or visiting PCPs. We leverage capabilities like accurate and early identification, in-the-moment engagement and quality of care on connected platforms to deliver personalized behavioral health with the right resources and level of care at the right time, reducing total cost of care - with an emphasis and focus on measurement throughout the member journey.
Our goal at Evernorth is to break down the silos to provide coordinated pharmacy, medical and behavioral care – we strive to provide the right care, at the right time, in the right place.
Doug: What you may not realize is that access is only a small piece of the problem - the member's individual needs are not the same for everyone - from the time to first appointment, matching to the right provider and delivering quality outcomes. Our provider matching is second to none, we have the ability to guide members to find the right level of care for them, the right provider that meets their needs and preferences, and makes them feel comfortable seeking and continuing with care. We also follow up to ensure members get the care they need and that no one falls through the cracks.
We’re also always looking for ways to improve and expand our network. We identify providers that will meet members’ diverse needs. For example, we are actively working on contracting virtual providers that focus on using evidence and cultural competency to improve access and efficacy for people in BIPOC (Black/Indigenous/People of Color) communities.
19.4% increase in the number of providers specializing in addressing cultural/ethnic issues
Our large network focuses on quality providers, with capabilities to deliver all modalities and acuity levels of care from text coaching to acute inpatient care, virtual and face-to-face appointments, across all specialties, with our provider match based on preferences, and need. Navigation support along with our data insights to proactively identify and engage members – access is not just quantity of providers but the right care at right time with the right provider throughout the journey. Clinical models are built to engage members early based on our data and ensure every individual is getting the immediate support they need.
96% of Evernorth customers would recommend their in-network provider
It’s important to address lack of access and high total medical spend and to choose a BH partner that challenges the status quo, delivering innovative BH care holistically and comprehensively without the need of added point solutions. Evernorth is the partner to do that.
Melissa: Engaging the member early and often is where we’ve seen the most success. We can understand where the member is on their behavioral health journey and identify issues and engage the member earlier on.
Holistic care and measurement throughout are also critical. We can see how a member’s overall behavioral health is improving and provide the right level of care when the member needs it.
Doug: Helping each member to find the right level of care is so important. Whether that is coaching or an in-person therapist – every member is unique and we need to personalize the care journey for them. This approach is more affordable and prevents behavioral health issues from developing into more severe and costly conditions.
To learn more about Evernorth’s suite of behavioral health solutions or its approach to behavioral healthcare, visit Evernorth Behavioral Health | Evernorth or contact firstname.lastname@example.org.