Jun 7, 2024
How The Cigna Group is streamlining the care experience for behavioral health providers

With behavioral health care in high demand in the United States, Evernorth is focused on connecting people with the care they need while also streamlining the experience for patients and providers, said Jana Dost (right), head of behavioral health provider network strategy and experience.

Evernorth, the health services division of The Cigna Group, bases its approach to provider partnerships on three key tenets: Simplification, transparency, and advocacy. “It should be easy for providers to care for plan members, there should be open communications about treatment progress and what is working and what isn’t, and plans should value the providers’ voice as much as they do their services,” Dost said.

“Strong working relationships between payers and providers benefit everyone, but most importantly, the patients,” said Helen Botsaris (left), senior director of national accounts at Brightside Health, which has providers in all 50 states and Washington, D.C., who deliver therapy, psychiatry, and crisis care for individuals with elevated suicide risk.  “A quality provider focuses on delivering the best possible measurement-based care while supporting the unique needs of the patient,” she said. “When paired with a collaborative payer partner, such as Evernorth, they can easily identify solutions and resolve issues relating to contract management as well as create more personalized care paths for patients.”

Read on to learn some of the ways Evernorth partners with network providers to advance behavioral care.

Accelerating availability and access to care

Evernorth Behavioral Health, which powers Cigna Healthcare’s behavioral offering, has more than doubled the number of contracted providers in its network over the past four years.

When Evernorth contracts with a large provider group, it uses a credentialing process with minimal administrative burden, which enables qualified clinicians to see patients in need more quickly.

“Evernorth’s credentialing process is one of the easiest and most efficient that we have seen in the industry,” said Brett Shrewsbury (right), chief commercial officer for Meru Health, which offers a center-of-excellence digital solution supported by hundreds of licensed therapists. “Instead of taking four months to get providers credentialed, it only takes a couple of weeks,” he said.

Kendall Pittinger (left), principal, payer partnerships at Headway, concurred. “On average, new Headway therapists and psychiatrists are credentialed in under 12 days, so they can begin seeing Evernorth members really quickly,” she said.

Headway has built a network of more than 30,000 therapists and psychiatrists, the largest in the United States.

Evernorth has also streamlined the experience for providers and patients by removing prior authorization requirements for routine outpatient care for mental health and substance use disorders. “We always aim to simplify the care delivery experience where we can so clinicians can easily provide the services their patients need," Dost said. In addition, prior authorization is no longer needed to enroll patients in intensive outpatient programs.

Dedicated support for providers

A dedicated team is available 24/7 to quickly review providers’ requests for the few behavioral health treatments that require prior authorization. “Clinicians can always get through, and we’re always monitoring that to make sure we’re providing the best possible service,” said Dr. Douglas Nemecek (right), chief medical officer for Behavioral Health.

In addition, Evernorth’s provider experience team supports all network providers, promptly addressing operational issues that may impede care. “It’s a true collaboration to overcoming challenges that benefits everyone, especially the patients who continue to receive a seamless care experience,” Dost said.

Provider groups that serve large numbers of Evernorth members are assigned a dedicated provider advocate. “Each one of our high-volume group providers know the name of the Evernorth advocate to call if they have a concern,” Dost said. “These providers know that they are going to talk to a person who knows them and their practice, so they can get right into the purpose of the call without having to re-introduce themselves.”

Headway has found that having a dedicated advocate offers greater efficiencies for their providers. “Having a single point of contact at Evernorth has led to quicker resolutions, which on average is just under two days,” Pittinger said. “This enables us to address any potential issues within the network more effectively and ensure a smoother experience for both providers and patients.”

Elisabeth Morray, Ph.D. (left), vice president of clinical operations at Alma and a practicing clinician, appreciates the level of support Evernorth provides to practitioners who had never been in a managed care network before. “Many Alma providers who join Evernorth’s network are taking insurance for the first time, which can seem daunting,” she said. Morray added that Alma and its Evernorth advocate work together to enable these providers to get answers to all their questions quickly and easily. “It’s a simple and supportive approach to going in-network,” she said.

Alma, which has built a network of more than 22,000 therapists and mental health clinicians, shares Evernorth’s goal of supporting provider practices, which Alma says helps advance the behavioral health care system for providers and patients. “At Alma, it’s our job to advocate for our community of providers,” said Kate Mellor (right), senior vice president of payer strategy and partnerships at Alma. “Evernorth’s provider experience team is advocating for us and our provider community across their enterprise.”

Provider advocates meet regularly with their provider group partners, enabling them to share patient feedback and other insights that can enhance the provider’s practice and Evernorth’s care management.

“The quarterly meetings led by our provider advocate provide a valuable platform for sharing data and discussing issues and concerns,” said Brightside’s Botsaris. “We've been able to deepen our conversations and tactics around how to increase awareness of product changes and new programs and how to better bring life-changing behavioral health care to more people who need it.”

Data and certifications help ensure quality of care

One of Evernorth’s enhancements involves measuring and reporting each high-volume provider’s performance in terms of quality of care, cost efficiency, and positive outcomes. Meanwhile, Dost said, “providers can continue to focus on seeing their patients, while Evernorth and their provider group will take care of tracking and delivering the performance data.”

Mellor noted that Alma is aligned with Evernorth in delivering measurement-based care. “We’ve been impressed with how the provider experience team uses data from claims, member service inquiries, and directory searches to identify opportunities to enhance the patient experience, all in partnership with our team here at Alma,” she said.

While the measurement-based program is currently available to large provider groups, all network providers are eligible to take part in certification programs, which recognize specialists with expertise in treating children, adolescents, people with autism, and people undergoing cancer treatments.

The facilities in Evernorth’s nationwide network include almost 550 centers of excellence that have demonstrated positive outcomes in treating mental health disorders, substance use disorders, eating disorders, and children and adolescents.

Brightside shares Evernorth’s commitment to providing quality care and improving health outcomes and is not new to measuring outcomes. For example, 86% of its patients experience clinically significant improvement, with 71% reaching remission within 12 weeks. Patients who engage with Brightside’s Crisis Care program, a national telehealth service for individuals with elevated suicide risk, experienced declines in depressive symptoms, anxiety symptoms, suicidal ideation frequency, and suicide-specific risk factors.

Evernorth’s commitment to quality was also a key factor in Meru Health’s decision to partner with the organization, Shrewsbury said. He noted a recent report showing that more people are receiving care, but few say they are in good mental health. “Many health plans tend to focus on increasing access to mental health care, but access is of little value if the quality of care is not keeping up,” Shrewsbury said. “Evernorth is very adamant about delivering quality care to their members, and that aligns with our goals at Meru Health.”

New approaches to care promote holistic health

Evernorth’s focus on quality behavioral health care includes partnering with provider groups that offer innovative approaches to treatment. One is Meru Health’s center of excellence program, which combines virtual therapy sessions with interactive digital exercises to help people manage stress, anxiety, and depression. Shrewsbury said 85% of participants saw their symptoms improve within 12 weeks.

“There are always new and amazing innovations in behavioral health care, but those innovations cannot make an impact unless we have the health plans on board to deliver them,” Shrewsbury said. “Evernorth was the first national partner to embrace our innovation, and that is going to help move the needle on revolutionizing behavioral health.”

In addition to enabling member access to Meru Health’s innovative program, Evernorth is collaborating on ways to leverage the program to support members who have had cardiac surgery, are undergoing cancer treatment, or are managing diabetes, Shrewsbury said. “Linking mental and physical health is an obvious strategy for every health plan in the market, and Evernorth is ahead of the game compared to others currently in this space.”

Exploring new ways to strengthen provider partnerships

Evernorth’s partnerships with behavioral health providers is yielding impressive results: In 2023, 94% of customers said they would recommend their in-network providers, and less than 2% of providers chose not to remain in-network with Evernorth.

The company continues to explore new ways to strengthen provider partnerships, including the launch of a provider advisory panel later this year to help inform behavioral health innovation. This panel will include network providers with various behavioral health specialties and in locations across the country.

“We value the work our network providers are doing with their patients, and we value their input in how to align new Evernorth solutions with their practices and operations,” Dost said. “This panel is just one more way we partner with providers to find out how we can work better together.”

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