BCBS NC, Quartet Partner to Implement Value-Based Payment Model

Blue Cross and Blue Shield of North Carolina and New York City startup Quartet have announced a partnership to implement a new value-based payment model for mental healthcare.  

The collaboration will combine both organizations' assets to measure the quality of care patients receive. It will also better compensate providers for improving patients’ health and offer incentives to providers for improved patient access to in-network care, collaboration among providers, and improved patient health outcomes.

This model integrates with Blue Cross NC’s current value-based payment model, Blue Premier, which was implemented on January 1, 2020. Blue Premier rewards health providers with incentive payments for improvements and meeting benchmarks while also ensuring patients access to high-quality care. 

 “It’s time for our healthcare system to treat the patients as one person, not as someone with the physical health needs and someone with behavioral health needs,” Kate Hobbs Knutson, MD, Blue Cross NC head of behavioral health said in the announcement. 

This move comes as mental and behavioral healthcare in America are found lacking. A separate Millman report uncovered that patients have trouble accessing affordable mental health and substance abuse treatment due to lack of participation in health plan networks and shortage of providers.

But the new Blue Cross NC payment shift bolsters efforts from the healthcare industry to better integrate behavioral health with physical health to transform healthcare through value-based payments. 

At the backbone of this effort is the partnership with Quartet. Last year, Blue Cross NC began offering Quartet’s services to primary care and mental health providers at no charge. Through this work, Quartet has been able to better recommend patients to mental health providers who best meet their care needs.

“There’s no standard of care for mental health in America, and Quartet is ready to change that,” said David Wennberg, MD, MPH, CEO of Quartet. “It’s time that we listen to patients and ensure that they can get the high-quality mental healthcare they deserve.”

In beginning initiatives, Blue Cross NC will attempt work with additional health plans to implement value-based payments across the country.

“Our technology will help people get the best mental health care for their needs and allow mental health providers to be recognized and reward for improving patients’ health,” Wennberg explained. “This work acknowledges what we’ve long known: mental health is healthcare.” 

Blue Cross NC invited behavioral health providers to participate in Blue Premier Behavioral Health. Independent, outpatient providers who serve Blue Cross NC commercial members can enroll by May 31, 2020. 

This latest move from Blue Cross NC highlights the industry’s work to integrate mental or behavioral health with physical healthcare.

For some, this starts with payment parity.

In late 2019, Herb Harbin, MD, a psychiatrist and an advisor to The Bowman Family Foundation, and his team found that mental health parity and disparities from 2013 to 2015 showed significant progress.

But to their surprise, when they decided to extend their report to five years, they uncovered decreases in access to behavioral healthcare and provider reimbursement. 

The industry had taken leaps backwards, but payers may have improved their pay and access parity, Harbin indicated.

“The payers and the employers, they’re the only hope to fix this,” he said.

Harbin pointed to the Path Forward initiative. 

The Path Forward for Mental Health and Substance Use was launched in November 2019 by the National Alliance of Healthcare Purchaser Coalitions (NAHPC) and aimed to strengthen mental health parity through stakeholder partnerships. 

“What we have developed is an approach that is thoughtful and comprehensive in terms of how we need to approach rebuilding a health system that can support people with mental health and substance use,” says Michael Thompson, NAHPC president and CEO.

The initiative uses evidence based, cost-effective, and strongly endorsed methods to improve behavioral healthcare network access, integrate behavioral healthcare into primary care through collaborative care, improve quality measurement in behavioral care, use telehealth more effectively to produce telebehavioral solutions, and ensure mental healthcare parity laws are recognized and pursued.