Learn about the actions BlueCross BlueShield of North Carolina (Blue Cross NC) took as part of a payer-based strategy to improve behavioral health access, quality, and efficiency.

The COVID-19 pandemic has had a significant impact on health care, and individuals with behavioral health issues remain an extremely vulnerable population. With access to behavioral health care already limited and lacking pre-COVID, the public health emergency has added a new layer of urgency to the issue.

Prior to the global pandemic, Blue Cross NC implemented a long-term strategy to drive improvements in the behavioral health space, write Katherine Hobbs Knutson, M.D., M.P.H., chief of behavioral  health, and Rahul Rajkumar, M.D., J.D., chief medical officer and senior vice president in a recent blog post for Health Affairs. Once the pandemic hit, they were able to adapt the program to continue to meet member needs.

Blue Cross NC originally developed the payer-based strategy due to several limitations in behavioral health care, they explained, including a shortage of behavioral health providers; many providers would not join networks due to low reimbursements; patients declined treatment due to high out-of-pocket costs; and providers failure to adopt measurement-based care s or technology infrastructure.

The authors shared the five-step approach the not-for-profit health insurer followed that lead to improvements in behavioral health access, quality, and efficiency:

  1. Eliminate carve-out: Blue Cross NC aligned behavioral health with the existing functions of physical health rather than follow the “carve-out” of behavioral health management and reimbursement that payers typically contract with behavioral health care organizations, which frequently causes misaligned incentives, reduced service use, and overlooked medical expenses.
  2. Integrate care: Integration of behavioral health with primary care allows primary care physicians to offer first-line treatment and address all health conditions in one appointment with a trusted provider. Blue Cross NC offers QuartetHealth, a behavioral health care technology service, free of charge to all providers to encourage integration (Rajkumar is an observer member for the board of Quartet Health).
  3. Increase payment through value-based reimbursement: The insurer rewards providers who measure and report health outcomes in Quartet through two value-based contracts: the basic pay performance, which is ideal for smaller practices, and the advanced model sensitive to the total cost of care, which is intended for larger, multidisciplinary practices.
  4. Deploy point solutions at scale: To alleviate the high cost of substance use disorders, Blue Cross NC launched a thorough provider outpatient substance use treatment, Eleanor Health, which incorporates in-person and virtual medication and therapy to address opioid and other substance use disorders as well as mental health issues including depression and effects from trauma (Hobbs Knutson is an observer member for the board of Eleanor Health).
  5. Measure impact: The insurer measures each initiative to address behavioral health in isolation as well as collectively.