Basing payment on clinical outcomes rather than the volume of service is increasingly common among medical practitioners, yet value-based reimbursement is less common among behavioral health practices. In a new paper published in The Journal of Mental Health Policy and Economics, “Has Value-Based Reimbursement Arrived for Behavioral Health? A Payer Perspective,” ¹ five experts from The Cigna Group^SM outline the advantages and challenges of making value-based reimbursement arrangements the norm for behavioral health.

“The psychiatric profession has experienced several paradigm-shifting breakthroughs in recent decades,” said coauthor Stuart Lustig, MD, MPH, National Medical Executive, Behavioral Health Strategy and Product Design, The Cigna Group. “We believe the next frontier in behavioral health is value-based reimbursement, which aligns reimbursement with presumably better care of individuals and populations at a time of increasing scrutiny on cost, quality, and outcomes.”

Challenges to value-based reimbursement

Value-based care reimbursements incentivize better care by rewarding outcomes, such as reduced time to care, improved clinical scores, patient quality of life, and reduced emergency department utilization. However, this reliance of data creates a significant hurdle in behavioral health practices because only 20 percent use measurements in their practices.²

A technology gap³ is another issue. There has been a slower adoption of behavioral health providers using electronic health record systems compared to hospitals.

Another challenge is the shortage of mental health practitioners in payer networks. Unlike their non-psychiatric colleagues, many psychiatrists operate cash-only practices, with only 55.3 percent accepting private fee-for-service insurance compared to 88.7 percent of physicians in other specialties. This trend is driven by lower reimbursement rates and administrative burdens. Payers have been hesitant to drive value-based reimbursement due to the need to maintain robust networks for their customers amidst a nationwide shortage of psychiatrists.

How measurement-based care improves outcomes and efficiency

Outcomes are better and achieved more quickly⁴ when practitioners measure care and design treatments to obtain specific goals, the authors concluded.

“Ultimately, we believe that an increasing number of practices and facilities will have an increasing number of patients in value-based reimbursement arrangements, dependent upon candid conversations about how incentives will be paid,” the authors wrote, adding that the willingness of providers to work with payers leaves them optimistic about the future of value-based reimbursement in behavioral health care.

Our commitment to advancing value-based care

Evernorth^® Behavioral Health launched a measurement-based care program in 2023⁵ with the goal of enhancing patient outcomes through alignment with providers on meaningful, standardized metrics for behavioral health care.

“Today, more than 53,000 providers are participating in our measurement-based care program,” said study co-author Douglas Nemecek, MD, MBA, Chief Medical Officer, Evernorth Behavioral Health. “Our ongoing strategy involves building collaborations with key providers committed to quality outcomes and creating, with their partnership, interventions that will benefit patients, employer groups, and behavioral health professionals alike.”

This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by the Evernorth Behavioral Health editorial team and subject matter experts.

1  Stuart L. Lustig, MD, MPH, et al. Has Value-Based Reimbursement Arrived for Behavioral Health? A Payer Perspective. International Center for Postgraduate Medical Education. 1 December 2024. Retrieved from http://www.icmpe.org/test1/journal/issues/v27i4toc.html.

2  Cara C. Lewis, PhD, et al. “Implementing Measurement-Based Care in Behavioral Health.” JAMA Psychiatry. 19 December 2018. Retrieved from https://JAMAnetwork.com/journals/jamapsychiatry/article-abstract/2718629.

3  “June 2022 Report to Congress on Medicaid and CHIP.” Medicaid and CHIP Payment and Access Commission. Retrieved from https://www.MACPAC.gov/publication/june-2022-report-to-congress-on-medicaid-and-chip/.

4  Jessica Waldrop, et al. “Measurement-Based Care in Psychiatry.” Journal of Psychosocial Nursing and Mental Health Services. 1 November 2017.  Retrieved from https://PubMed.NCBI.NLM.NIH.gov/28840934/.

5  “Case study: Standardized behavioral health metrics drive improved access and better health outcomes.” Evernorth Health Services. 22 October 2024. Retrieved from https://www.Evernorth.com/articles/case-study-standardized-behavioral-health-metrics-drive-improved-access-and-better-health.