Payer Seeks to Balance In-Person, Virtual Mental Healthcare

Members ask themselves three questions when considering their own mental healthcare needs, according to Cara McNulty, president of behavioral health and the Employee Assistance Program at Aetna.

First, they ask, “do I need help?” If the answer is yes, then they must consider, “where do I go to get help?” And along with that question, they have to determine, “what kind of help do I need?”

The payer industry was not originally outfitted for addressing those questions, but in recent decades—and particularly as a result of the coronavirus pandemic—payers have embraced their role in helping their members find answers.

“The pandemic is having a large effect on the totality of people's mental health wellbeing,” McNulty told HealthPayerIntelligence. “The number of people that we know go undiagnosed, especially in populations of color, is far too high.”

The challenges may not be novel, but the widespread urgency around making mental healthcare solutions more accessible is more evident than at any other time in modern history.

During the lockdown, payers and members naturally turned to digital platforms in order to address the swell of mental healthcare needs.

However, with the pandemic becoming more manageable and the country preparing to emerge from the public health emergency, payers have to consider how to transition these solutions into the new normal.

Aetna is developing in-person and virtual care mental and behavioral health solutions side-by-side as well as employing an omnichannel approach to expand access to care as the nation tries to move beyond the pandemic.

CVS Health and its payer arm, Aetna, have developed an in-person solution through CVS HealthHUBs, which are locations that provide access to a range of preventive and primary care services and products.

“We have put licensed clinical social workers at these locations and those social workers are there to help provide mental health assessment, referrals, counseling, help you develop a personalized care plan,” McNulty said.

These clinical social workers are not specific to Aetna, but rather they are payer-agnostic, making this solution more broadly applicable for the communities in which the pilot’s HealthHUBs exist.

“That licensed clinical social worker also helps you look at, ‘Okay, what insurance do I have, maybe through my employer or as an individually-insured person? What are the services I have available and how could I utilize those benefits?’” McNulty explained.

For those who do not have insurance, the clinical social worker can help patients find support through community-based organizations.

“It really democratizes access to care,” McNulty added.

The HealthHUBs mental healthcare pilot also addresses existing challenges regarding a shortage of mental and behavioral healthcare providers by integrating clinical social workers.

“Instead of adding more pressure in an already tight ecosystem, where there are not enough providers, it helps us to have providers working at the top of their practice,” said McNulty. “Utilizing that licensed clinical social worker as the front door is a great way to get people the care and support that they need. It's personalized, it's simple.”

Currently, the pilot is operating in 12 HealthHUBs in Houston, Philadelphia, and Tampa. However, by the end of the first quarter of 2021, the healthcare company expects to have expanded this approach into 34 HealthHUBs.

While scaling this pilot, CVS Health is concocting a virtual care solution that can mirror the in-person program.

“Right now, this is an in-person service, but we are building out the exact care to be virtual as well because, with the pandemic, not everybody wants to come into a HealthHUB,” McNulty acknowledged. “We've had an unbelievable increase in the utilization of our virtual care offerings. So we're building this both for brick and mortar, in-person care and virtual care, to meet the needs of the consumers and patients.”

By establishing multiple settings and avenues for accessing care, Aetna is pursuing an omnichannel approach to mental and behavioral healthcare.

The payer intends to create some fluidity between the virtual care option and the in-person option. Patients could start behavioral or mental healthcare treatment through virtual care and then switch to receiving care in person or proceed in a hybrid fashion.

“No two people are the same and everyone's mental health journey is different, so we don't want there to be one door for you to enter,” McNulty explained.

The omnichannel approach has been useful for the payer industry outside of addressing mental healthcare.

For example, Blue Cross Blue Shield of Minnesota (BCBSMN) leveraged this method in order to bolster its member engagement strategies. By offering multiple avenues for member-payer communication, BCBSMN found that it was able to improve its feedback process and expand telehealth solutions.

In member engagement, omnichannel approaches can leverage social media, calls, websites, mobile messaging, chats, contact centers, video calls, and emails or postal mail, a McKinsey article outlined.

In order to build out the virtual and in-person solutions in tandem, McNulty said that the payer has focused on keeping the individual patients and their ecosystems—including their families—at the center of care.

“We start by keeping the individual that we're supporting and their ecosystem at the center of this equation,” McNulty shared. “Then we look at, ‘What are the problems that get in the way of people seeking care?’ And when we think about virtual care, we even broaden that to: ‘What is our omnichannel approach to removing barriers for people to get the care and support that they need?’"

Looking to the future, McNulty emphasized that payers need to consider mental health as a part of whole-person health.

“As payers, we need to start to address the whole spectrum, that whole continuum. We also need to advance the thought that heads and hearts are not separate,” McNulty argued. “Taking care of mental health as well as physical health has to be integrated.”