Big payers want behavioral health partners who can be more than a flash in the pan

Behavioral health point solutions are increasingly looking to make lucrative partnerships with payers.

Payers are also interested in the prospect of partnering with digital health companies to bring more behavioral health services to their members. But there could be a culture clash between the two entities. That’s why it’s critical to have agreed goals, outcomes and expectations, say stakeholders on both sides.

“Many of us have more than 50% market share in the state we live in,” Suzanne Kunis, vice president of behavioral health at Horizon Blue Cross Blue Shield of New Jersey, told HLTH. “We have the ability to change the way things happen there.”

Horizon Blue Cross Blue Shield of New Jersey is a health insurer that provides coverage to 3.8 million people.

Behavioral health has become a major focus for payers as rates of depression and anxiety continue to rise. In response to this crisis, more than $5.5 billion in venture capital was invested in digital health solutions.

“There are advanced conversations, new innovations, the largest venture capital investment in behavioral health — ever,” Cara McNulty, president of behavioral health and mental wellness at CVS Health (NYSE: CVS ), told HLTH. “So the art of opportunity is here, but we all have to take it and apply it so that the people we serve really feel those results.”

CVS Health is the parent company of Aetna.

Specifically, payers are looking for areas where they have the greatest opportunity to make an impact, Kunis said. This means targeting expensive areas with high demand. Niche solutions that can serve only a small portion of the population will be lower on the payer’s priority list.

It can also help when payers understand where a point solution fits in the continuum of care.

“The way we look at it is what are the problems that we see as the most important for our customers that we need to solve in the short, medium and long term,” Eva Borden, president of behavioral health at Evernorth, told HLTH . “It’s really about being able to chart startups and tell who falls into which group and who has a long-term trajectory. Not only to be the flash in the pan today, but you can see that they can build.”

Evernorth is the health services division of giant Cigna Corp. (NYSE: CI).

red flags

With hundreds of behavioral health point solutions on the market, finding the right fit can be a difficult task for payers.

“It’s a huge job to try to create that kind of relationship,” Kunis said.

This can put additional pressure on startups to get the initial interaction right from the start. But honesty may be the best policy when creating partnerships for a point of payment solution.

“When you get the opportunity to offer a health plan, do yourself a favor — be honest,” Kunis said. “Tell the truth. Where are you? What is reality? Don’t make up a story that won’t happen.”

Being open about what problems a point solution can and can’t solve is helpful for payers, McNulty said. Specifically, it can help payers understand where this solution fits in the healthcare ecosystem—and set appropriate expectations.

In general, payers are looking for stability in both products and leadership, Kunis noted. And flashy offers won’t necessarily work to woo payers.

“When you come in and start telling me from Day 1 that you’re going to take [risk-based approach] about my membership, that’s a big issue for me,” Kunis said. “All this means to me is that you’re a startup, you’ve got some VC behind you with a bucket of money saying, ‘Let’s get in there, make it easy for them.’

It’s also okay to ask questions, Borden said. If a potential partner isn’t an expert on health plans and isn’t sure about the health ecosystem, it’s better to ask than to guess.

Path to partnership

To help facilitate point-of-care payer solution partnerships, many payers have created a formal process where startups can pitch their solutions.

For example, CVS has a team dedicated to partnerships. It also has a strategy that identifies gaps and needs. This strategy is then used to help him evaluate potential partners. The team evaluates over 500 potential partners annually. Additionally, on a quarterly basis, there is a shark-like process that evaluates potential partners.

“I want to know what you decide and why,” McNulty said.

It’s also important for payers to view point solutions as true partners, not vendors. A key part of creating this partnership is aligning goals.

“We can have an honest dialogue about what those agreed-upon goals are,” Borden said. “Then I see partnerships going a long way because it’s a really virtuous way of helping each other.”

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