Technology adoption could change how patients, providers and payers experience the behavioral health industry.
Leaders of the behavioral health tech startup NOCD and Evernorth, the services division of The Cigna Group (Nasdaq: CI), point to their partnership as an example of using technology to change the current combative nature of payer-provider relations into productive, patient-centered collaborations. And in the end, that improves patient care and outcomes.
“For years, providers and payers have gone to the negotiations table and done their fisticuffs for that 3%,” Robert Capobianco, NOCD chief marketing officer and payer market president, said at Behavioral Health Business’ event VALUE. “That is not the spirit of a value-based agreement or alternative payment.”
For NOCD and Evernorth, one path to improving behavioral health comes through tech-enabled value-based care models for those with obsessive-compulsive disorder (OCD). OCD is a serious mental illness (SMI).
“The reason that we’re committed as a payer at Evernorth to getting [value-based care] in place is that this is what aligns us to where we want to get,” Doug Nemecek, behavioral health chief medical officer for Evernorth, said. “We’re trying to tell people … this is where you are going to get the best care, where we can promise the best chance of having that outcome that you’re looking for.
“It gets us as a payer, out of the world of just paying for something that happened and something was done that may or may not have added value to anything that was of importance to the individual patient.”
Large payers have been interested in collaborating with technology-backed services from health care providers for some time. Top motivators include ease of care access, convenience, privacy and highly specialized services. Other startups to land deals with large payers include Quit Genius, Brightline and Ophelia Health.
NOCD is a digital mental health provider for patients with OCD. The Chicago-based startup launched in 2014 and has raised $84 million. Its latest funding round, announced in February, totaled $34 million. Cigna Ventures and 7wireVentures co-led the round.
Behavioral Health BusinessInside the partnership
When fully realized, the NOCD and Evernorth partnership helps prevent a years-long cycle of misdiagnosis and mistreatment. Along the way, the stereotypical OCD patient journey generates massive costs and anguish for patients, not to mention the strain on providers and payers serving these patients.
Nemecek said value-based care models that focus on data have the potential to apply to other SMIs as well, opening up new avenues for caring for complex patients that often need several services outside of health care.
NOCD CEO Stephen Smith has lived experience with OCD. He said the condition is poorly understood by American society as well as most health care providers. The intrusive, often taboo, thoughts that drive ritualistic compulsions are misunderstood as generalized anxiety.
Instead of receiving exposure and response prevention (ERP) therapy, which Smith said is the “gold standard” treatment for OCD, patients receive psychotherapies that have no scientific backing in treating the condition.
“So when that happens, not only is that not effective care for the patient, but also in some cases even harmful,” Smith said.
Patients with severe cases of OCD are likely to experience mild symptoms after three months of ERP treatment, Smith said. And given the extent to which OCD lurks with SMI diagnoses, there is a chance to make a systemwide impact on care and cost efficiency.
Between 1 in 50 or 1 in 33 Americans are estimated to have OCD, according to one study.
Behavioral Health Business“If you can get them the right care at the right time, you can make a big difference,” Smith said. “That, for us, is an opportunity to look into the healthcare ecosystem more and figure out how to identify folks at scale and then serve them in an effective way.
“And if we do that, then we’re going to reduce utilization in the system that can then free up availability to serve other folks who might need it more.”
By proactively identifying OCD patients and routing them to care, value-based care arrangements can prevent a “traumatic journey” for many patients, Capobianco said.
He noted that misdiagnosed or mistreated OCD patients consume an enormous amount of talk therapy to no effect and often escalate up the behavioral health spectrum to intensive outpatient programs (IOPs) to deal with the intrusive thoughts. Patients keep escalating until a provider happens upon the correct diagnosis.
“This was a round trip for these patients — they would start out their low acuity was in visits only and then transition into these higher levels of care to never get better,” Capobianco said. “We put them through the facilities and the SSRIs and the pieces and the intrusive thoughts stay.
“And to me the biggest benefit for the payer there is, yes, to intercept [patients] early and get them to the right care at the right time. At the same time, think about the journey that the patient just went through. That’s probably six months of their life. That never had to happen. On average, OCD patients take 10 to 14 years to find care.”
