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Blue Cross NC, Quartet roll out value-based payment model for behavioral health

Blue Cross NC, Quartet roll out value-based payment model for behavioral health

posted by: Nicole Hovey date: Feb 11, 2020 category: Blog comments: Comments Off on Blue Cross NC, Quartet roll out value-based payment model for behavioral health

As the U.S. healthcare landscape moves from fee-for-service to value-based payment (VBP) models, value-based care has been difficult to implement for behavioral health and addiction treatment. A new model from Blue Cross and Blue Shield of North Carolina, however, could help encourage broader VBP adoption in behavioral health.

Blue Cross NC’s New Model

Blue Cross NC is collaborating with New York City-based startup Quartet in its launch of a VBP model for behavioral healthcare. This model, called Blue Premier Behavioral Health, will give behavioral health providers incentive payments for certain improvements and for meeting benchmarks in quality measures. This partnership is also meant to encourage cooperation between providers and improved patient outcomes.

Under the collaboration, launched January 1, 2020, Blue Cross NC and Quartet will combine assets to measure clients’ quality of care. Eligible providers will be able to use Quartet’s technology to collect data and measure quality outcomes, while supporting improved patient care.

This plan also integrates with Blue Cross NC’s value-based program, Blue Premier. Under this care program, both providers and Blue Cross NC are accountable for improving patient care and reducing costs.

According to Blue Cross NC’s official announcement, the new Blue Premier Behavioral Health builds on the company’s efforts, started in 2019, to better integrate behavioral and physical health care. Last year, the payer began to offer Quartet’s services for free to both primary care and mental health providers.

With Quartet’s technology, providers can refer patients to appropriate behavioral health providers. It also allows providers to collaborate for the care and support their patients need.

The new Blue Premier Behavioral Health could help provide better access to high-quality, coordinated care for behavioral health and addiction treatment clients. Because this change is so revolutionary, it could serve as an example for other health plans looking to adopt VBP models for behavioral health.

Challenges for VBP in Behavioral Health

As primary care providers struggle to address their patients’ mental health and substance misuse needs, physical and mental health integration becomes increasingly necessary. Despite the increased need for better behavioral health integration, however, there are still significant disparities between access to behavioral health services compared to physical health services.

A 2019 report from Milliman, Inc. found that inpatient, out-of-network use of behavioral health services was five times more likely than for medical/surgical services, an increasing gap compared to 2013. The report also found that office visit disparities between behavioral and physical health were five times higher in 2013 and increased to 5.4 times in 2017.

By establishing a VBP model for behavioral health, Blue Cross NC’s example may help close the gap between physical and behavioral health coverage, while also improving patient outcomes and lowering costs.

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