Quality care is at the heart of what you do – and it’s our mission, too. Thanks to your dedication and the guidance of our behavioral health quality committee, Evernorth^® Behavioral Health (Evernorth) has made real strides in service and clinical quality. Here’s what you helped us achieve in 2024 – and what’s next.

Notable improvements 2023–2024

Our network is growing – and so are our services. We expanded our behavioral provider network by 12.1% from 284,694 to 317,740 providers. That means more options and better access for your patients.

Key increases in contracted services include:

• Telehealth providers……………….. +23.8%
• Emergency responders…………… +23.7%
• Autism specialists…………………….. +15.8%
• Prescribers…………………………………. +15.4%
• Master’s level therapists………….. +12.4%

Our HEDIS^®1 ratings are showing significant gains. We are seeing significant advancements realized notable improvements in our HEDIS ratings.

• Antidepressant Medication Management (AMM): Acute phase rates improved to 75.4% (+0.9%) and continuation phase rates to 59.0% (+1.0%).
• Adherence to Antipsychotic Medication for Individuals with Schizophrenia (SAA): Improved to 64.8% (+2.1%).
• Diabetes Screening Among Persons with Bipolar Disorder or Schizophrenia Prescribed Antipsychotic Medication (SSD): Improved to 76.8% (+1.3%).
• Follow-up After Emergency Department Visit for Mental Illness (FUM): 7-day follow-up improved to 46.1% (+1.9%) and 30-day follow-up to 62.0% (+2.0%).
• Use of Opioids at High Dosage (HDO): Decreased to 3.4% (-0.3%).
• Risk of Continued Opioid Use (COU): 15 days of prescription use in 30 days decreased to 4.8% (-0.3%) and 31 days of prescription use in 62 days decreased to 1.7% (-0.1%).

Our customers are experiencing faster and better access to care. Access to services has improved notably.

• Behavioral follow-up after medical referral to case management within 30 days:
  • Improved to 27.8% (+2.2%).
    
• Appointment availability (prescribers):
  • Within 6 hours: 71% (+6%).
  • Within 24 hours: 61% (+20%).
  • Within 30 days: 90% (+5%).
    
• Complex case management:
  • Engagement rate: 31.6% (+1.0%).
  • Completion rate: 92.3% (+3.9%).

Achievements that matter
Among our quality achievements, we:

• Completed the National Committee for Quality Assurance (NCQA) Managed Behavioral Health Organization Corrective Action Plan – earning full accreditation.
• Met all goals for geo-availability studies, inter-reviewer reliability exercises, and provider directory accuracy.
• Launched a pilot project using the Verint survey tool to gain a better understanding of customer satisfaction in case management.

What’s next? Opportunities for 2025
Here’s what we’re focusing on next – with your partnership:

• Speeding up utilization management requests and appeals.
• Improving clinical HEDIS rates and other clinical measures.
• Identifying, in real time, customers admitted to the emergency department for mental health or substance use issues.
• Utilizing HEDIS data to identify opportunities and launch pilot interventions.
• Deepening integration with medical providers.
• Improving complaint resolution and access to care.
• Enhancing reporting across utilization and case management systems.
• Improving the effectiveness of products and services to meet customers’ needs.
• Continuing to backfill open positions and forecast staffing needs.
• Ongoing staff training and development.
• Integrating more tools and resources on the Evernorth provider website (Provider.Evernorth.com).

Additional information

For more information or to share feedback, please reach out to Provider Services at 800.926.2273. Together, we’re making behavioral health care better for everyone.

1    Healthcare Effectiveness Data and Information Set (HEDIS) is a registered trademark of the National Committee for Quality Assurance (NCQA).