Evernorth Developing Measurement-Based Program for Behavioral Health

Oct. 11, 2023
Metrics include how long it takes a patient to get an appointment, avoidance of a higher level of care, and total cost-of-care savings

Evernorth Health Services, the pharmacy, care, and benefits solution division of The Cigna Group (NYSE:CI), is launching a measurement-based care program for its behavioral health network.

The Bloomfield, Conn.-based company sees this collaboration with providers as a first step as the industry seeks to create meaningful, standardized metrics for behavioral healthcare.

“We are identifying the most important measurements at each point in the patient journey and creating standard ways to capture them,” said Doug Nemecek, M.D., chief medical officer, behavioral health, for Evernorth, in a statement. “Our ongoing strategy involves building collaborations with key providers committed to quality outcomes and creating, with their partnership, interventions that will benefit patients, clients, and mental health professionals alike.”

As part of the program’s initial launch, Evernorth will work with over 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, substance use disorders, and more. Evernorth 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.

“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, in a statement. “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. This is the first step as we seek to actively collaborate with providers, as enhancing the provider experience is critical to the success of measurement-based care. We are creating a program that will deliver best-in-class clinical outcomes and multi-stakeholder affordability.”

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 this 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.

“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,” Nemecek explained. “We want our providers to be focused on patient care and not on paperwork, and we plan to incorporate measurement in ways that minimize the administrative burdens and maximize the benefits for providers and patients. By embedding shared metrics in the customer journey, both payers and providers will develop insights into access and outcomes that will benefit everyone.”

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