Your commitment to delivering quality behavioral health care helps improve access, service, and clinical outcomes for patients. With input from our behavioral health quality committee and continued collaboration with providers like you, Evernorth^® Behavioral Health (Evernorth) made important progress in 2025. Here are key quality findings from the past year and areas of focus for 2026.¹

Notable improvements from 2024 to 2025

The Evernorth network is growing – and so are the services being provided. The behavioral provider network has increased by 8.1 percent from 317,740 to 343,413 providers; resulting in more options and better access for your patients.

Key increases for in-network provider services include:

• Telehealth providers +24 percent
• Emergency responders +24 percent
• Autism specialists +16 percent
• Prescribers +15 percent
• Master’s level therapists +12 percent

Healthcare Effectiveness and Data Information Set (HEDIS^®)² ratings have improved.

• Antidepressant Medication Management (AMM): Acute phase rates improved from 75 percent to 76 percent. The continuation phase rates increased from 59 percent to 60 percent.
• Diabetes Screening Among Persons with Bipolar Disorder or Schizophrenia Prescribed Antipsychotic Medication (SSD): Improved from 77 percent to 78 percent.
• Follow-up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA): Seven-day follow-up increased from 18 percent to 20 percent, and 30-day follow-up increased from 29 percent to 31 percent.
• Follow-up After Hospitalization for Mental Illness (FUH): Seven-day follow up improved to 45 percent to 47 percent, and 30-day follow up increased from 66 percent to 68 percent.

Customers are experiencing faster and better access to care.

• Behavioral Follow up after Medical Referral for Services: Engagement within 30 days increased from 21 percent to 23 percent.
• Unplanned Behavioral Readmissions: National readmission rate decreased from 8 percent to 7 percent, remaining well below the established goal of less than 10 percent.
• Appointment availability, where goals were met:
  • Initial routine care within 10 days with a prescriber: 78 percent
  • Office wait times – seen within 15 minutes of appointment with a prescriber: 90 percent
  • Initial routine care within 10 days with a non-prescriber: 85 percent
  • Follow-up routine care within 30 days with a non-prescriber: 93 percent
  • Office wait times – seen within 15 minutes of appointment with a non-prescriber: 94 percent
• Complex case management:
  • Engagement rate: 26 percent
  • Completion rate: 92 percent
  • Case management (CM) satisfaction rate: 94 percent

Achievements that matter

Evernorth’s quality achievements include:

• Successful completion of oversight audits with high scores (Managed Behavioral Health [MBHO] accreditation at approximately 97 percent and URAC^® accreditation at 100 percent).
• Continued expansion of digital tools, predictive modeling, and automation to improve access, reporting, and customer engagement.
• Ongoing staff training, cross‑functional collaboration, and optimization initiatives supported sustained program performance.
• Increased network and appointment availability through the Evernorth Behavioral Care Group (EBCG).

What’s next? Opportunities for 2026

Here’s what Evernorth is focusing on next:

• Improve timeliness of utilization management and appeals through enhanced monitoring, training, and automation.
• Sustain focus on improving HEDIS clinical measures using predictive analytics, targeted outreach, and integrated care coordination.
• Continue expanding provider networks and telehealth capacity in underserved specialties and markets.
• Advance digital transformation initiatives to improve data accuracy, reporting timeliness, and customer experience.
• Strengthen integration between medical and behavioral health programs, including coordinated case management and community support resources.
• Maintain workforce stability through recruitment, retention, and ongoing training efforts.
• Integrating more tools and resources on the Evernorth provider portal (Provider.Evernorth.com).

Additional information

For more information or to share feedback, please reach out to Provider Services at 800.926.2273.

¹ Internal findings compiled from different sources in the 2025 Behavioral Health Program Evaluation.

² Healthcare Effectiveness Data and Information Set (HEDIS^®) is a registered trademark of the National Committee for Quality Assurance (NCQA).