Evernorth eyes behavioral health with care management program

Photo: Basak Gurbuz Derman/Getty Images

In an effort to better align on quality care and reimburse providers for delivering improved health outcomes, Evernorth Health Services is launching a measurement-based care program for its behavioral health network.

This, said Evernorth, represents the first step in the company's active collaboration with providers as the industry looks to create meaningful, standardized metrics for behavioral healthcare. 

The goal is to better align payers and providers when it comes to measuring the success of medical treatments – which in turn would drive better care and lower healthcare costs, Evernorth said. And since providers often use a number of different measures across multiple payers, the organization expects the move will also ease administrative burden.

"Across the healthcare industry, we all understand the importance of measurement, and delivering quality behavioral health outcomes and care represents our next step in strengthening the interventions for our patients and deepening our relationships with providers," said Eva Borden, president, behavioral health, Evernorth. "Right now, there is a lack of consistent, repeatable measures – that are broadly agreed upon – resulting in more administrative work, and less trust, from our provider partners."

WHAT'S THE IMPACT

Measurement-based care – or value-based care – has long existed for physical health, but has not seen the same adoption in behavioral health, said Evernorth. In the journey toward behavioral measurement-based care, providers and payers have used a variety of measures, sharing them via spreadsheets or claims and document submissions to understand quality. 

The goal of the new program is to align on treatment measurements that can ultimately drive improvements in care, cost and collaboration, as well as remove administrative burdens for providers.

Dr. Doug Nemecek, Evernorth's chief medical officer, behavioral health, said the company is identifying the most important measurements at each point in the patient journey and creating standard ways to capture them, which involves collaborating with key providers on effective interventions.

As part of the program's initial launch, Evernorth said it will work with more than 44,000 providers, with plans to expand over time. The providers include behavioral health coaches, therapists and prescribers who can help with a variety of mental health conditions, including anxiety, depression, sleep disorders and substance use disorders. 

Evernorth said it has identified key metrics for the program to ensure that customers have quick access to high-quality care, including how long it takes a patient to get an appointment, avoidance of a higher level of care and total cost-of-care savings. The program will add to these measures over time as Evernorth engages with providers to align on best metrics.

"By tracking this information, we can help move the needle in partnership with our providers as we all work together to improve care for the people we serve," said Nemecek.

THE LARGER TREND

Evernorth, a subsidiary of Cigna, was a key part of the latter's financial performance in Q2 of this year; the insurer raked in $48.6 billion in revenues, with shareholders' net income hitting $1.5 billion, or $4.92 per share.

Total revenues and adjusted revenues for Q2 increased 7% from Q2 2022, which Cigna attributed to strong contributions from Evernorth, its health services division, and from Cigna Healthcare. Evernorth's revenue grew 10% to $38.2 billion.

Evernorth Health Services partners across the healthcare system to serve customers and clients, including health plans, employers, government entities and others. It creates pharmacy, care and benefits solutions. Its capabilities are powered by Express Scripts, Express Scripts Pharmacy, Accredo, eviCore, MDLIVE and myMatrixx.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com