Insurer Program Attempts to Integrate Medical & Behavioral Data

In an effort to improve health outcomes and lower costs, health insurer Cigna is launching a Collaborative Care Model pilot focused on integrating behavioral and medical care. The Cigna Better Connected Health program aims to discover and implement “mind and body” healthcare solutions by teaming primary care providers with behaviorists.

“I don’t know if any of you are Trekkies or familiar with Star Trek,” said Senior Medical Director of Behavioral Health William Lopez. “Forget about space. Integration of care is healthcare’s final frontier.”

Though publicly-supported programs have pushed integration with some success recently, Lopez said insurers have lagged behind. A lack of actionable clinical insights and goals and behavioral health resources in medical settings along with disjointed care teams and care plans have hurt outcomes for patients with multiple chronic medical and behavioral conditions.

“We don’t have the tools that the public sector has like waivers and grants,” Lopez said. “Currently the only payer that is reimbursing for these codes is Anthem and their Blue Cross plans. I’m not so sure that they are monitoring the proper elements of the Collaborative Care Model, though. What we’re trying to do is introduce more of this into the private sector.”

Moving forward, Cigna hopes to improve the delivery of care by identifying and engaging patients who may need additional care by using data analysis and record sharing between providers – a plan that requires patient consent. Once consent is received, providers are able to support the needs of the patients earlier, which leads to lower costs and better outcomes. “We are letting our providers know which patients might benefit from screening. The other group is identifying who has comorbidities.” This is crucial, since patients with at least one chronic medical and one behavioral health concern cost 2 to 3 times more.

Payer Negotiations

At the primary care-behavioral health congress in Florida in May, one question took center stage: which code reimbursements can be negotiated with providers? The consensus from representatives from groups including Cigna, Spectrum and Providence was that everything is negotiable. It was acknowledged, however, that this can often be difficult for individual providers. Wen Cai, Chief Medical Whole Health Officer of Spectrum Healthcare Group, said providers should focus on a personalized list of their highest-utilized CPT codes when negotiating contracts.

“You can get higher rates for low-complexity codes if you negotiate properly,” Cai said. “I’m not saying be hostile. A very well-designed contract is worth a million dollars. But if it’s a bad contract, once you sign it, it’s hard to renegotiate. If you can rationalize your reasoning for requesting higher rates up front, you can benefit. Use data.”

Dr. Lopez suggests banding together rather than negotiating ‘provider to provider’. “There is power in numbers.” he says.

Providence Health Plan’s Senior Director Courtney Esparza says you can do fee for service, but that can be tedious and sometimes underpaid. “But for something like addiction treatment, let’s say you offer intensive outpatient programs. In this case, it would be beneficial to aim for a bundle.”

-Report by John Boyle at Primary Care-Behavioral Health congress, May 2018

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s