May 10, 2024
How The Cigna Group is making behavioral health care easier to access

While demand for behavioral health services continues to increase in the United States, the number of licensed practitioners is not keeping pace. In fact, 50% of adults with a diagnosed behavioral health condition do not receive treatment. The underlying issues are complex, said Dr. Douglas Nemecek, chief medical officer for Behavioral Health at Evernorth, the health services division of The Cigna Group, and the company is working constantly to help our customers find and get the care they need, when they need it.

While most people know how to access medical care, a large number are unsure of how to navigate the behavioral health system. “If we tripped and twisted our knee and needed help, most of us could figure out what to do,” Dr. Nemecek said. “If one of us had someone in our family who had a behavioral health breakdown, most of us would not have a clue what to do, or even where to go to ask for help.”

Accelerating access to mental health treatment by removing prior authorization for outpatient services

Evernorth Behavioral Health, which powers Cigna Healthcare’s behavioral offering, has removed prior authorization from most behavioral health treatments. “Under our plans, routine outpatient mental health and substance use disorder care don’t require any prior authorization, so any customer can go to any in-network behavioral health provider,” Dr. Nemecek said.

In addition, clinicians no longer need prior authorization to enroll their patients in intensive outpatient programs, which are structured psychological treatment programs for behavioral health and substance abuse issues that require more intensive support than can be provided in routine outpatient care. “We have removed prior authorization requirements for 100% of routine outpatient services because we want to accelerate access to care and make sure people get the care they need, when they need it,” he said. At the same time, removing those requirements eases the administrative burden on providers.

For the rare treatments where prior authorization is required, a dedicated team of advocates is available 24/7 to review requests. “Clinicians can always get through, and we’re always monitoring that to make sure we’re providing the best possible service,” he said.

How to find behavioral health care

When their need is not acute, Cigna Healthcare customers have several ways to find a therapist, psychiatrist, social worker, or other behavioral health provider. By logging into myCigna.com, they can set parameters and access a list of nearby providers who meet their preferences and needs. The site’s navigation functionality has been significantly upgraded, Dr. Nemecek said.

In addition, patient advocates are always available by phone and by chat through myCigna to answer questions and ensure people get connected to care. “We can provide names of providers, and we can call providers to find available appointments for customers so that they don’t have to spend all day dialing through lists of possible providers to find somebody with an appointment that works,” he said. “We’re moving toward implementing the ability for us to actually schedule appointments with some providers, as we build technology connections.”

Patients often start their search for behavioral care by asking their primary care physician, friends, or family members for recommendations.

“If a provider has a patient who needs support, they can call us, and we can help guide the patient to a place where they can get that care,” Dr. Nemecek said. “If it’s an urgent situation, we will find an urgent appointment for the patient, or the provider can send their patient to the emergency room, and we will engage when the emergency room calls us and lets us know what they need.”

“We have 24/7/365 clinicians available here to talk directly with providers, but during the night or a holiday, often the call is from the member or patient who’s in some sort of crisis. We will help them get to an appointment, where they can see a clinician at whatever level of care they need, or we can go as far as calling an ambulance to take them to a crisis center or emergency room, if that’s what they need.”

In those urgent cases, the clinicians also try to notify a loved one so the patient will not be alone, then follow up the next day and again a few days later to make sure the patient got the care they needed, Dr. Nemecek said. “After that initial crisis is at least stabilized, that’s when people say, ‘I also have this issue and that issue, and that’s what’s making me stressed out. I need help.’ We’ll then be able to start addressing those other issues for them as well.”

The challenge and promise of behavioral health data

We’re also working to further improve the way we match people to the right provider for them, Dr. Nemecek said, which requires more and better data. That’s a challenge because medical data is much better integrated and available than behavioral data – in part because so many behavioral health providers are sole practitioners or in small groups. Many of them still use paper charts, Dr. Nemecek said. In addition, electronic records systems for behavioral health are different than the ones that are used for medical care, so data integration is an issue.

“We’re putting a lot of work into making sure we collect more data and can make better matches for individuals so they can feel comfortable talking to a therapist or a psychiatrist about what’s probably the most personal and intimate details of their lives” he said. “You need to feel comfortable with that, which is different than feeling comfortable with the surgeon who’s going to operate on your knees.”

Evernorth recently announced the Evernorth Behavioral Care Group, an outpatient behavioral health practice that will utilize Evernorth’s extensive medical, behavioral, and pharmacy data to expand access to quality, in-network therapy for millions of people. The group, which is now in six states and Washington, D.C., is expected to be available nationally next year. “This will accelerate our ability to provide individuals with better access to high quality behavioral health care,” Dr. Nemecek said.

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