Blue Cross NC, Quartet roll out value-based payment model for mental health

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is partnering with New York City startup Quartet to roll out a value-based payment model for mental health care.

Quartet and Blue Cross NC are combining their assets to measure the quality of care patients receive, and create incentives to providers for improved patient access to in-network care, collaboration among providers, and improved patient health outcomes, the two organizations said.

Blue Cross NC’s value-based payment model, called Blue Premier Behavioral Health, will reward mental health providers with incentive payments for achieving improvements and meeting benchmarks in quality measures. Eligible providers will use Quartet’s technology to support improved patient care, as well as enable data collection and measurement of quality outcomes.

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Through this work, Quartet will be able to better match patients to providers who meet their clinical needs, the organizations said. 

Kate Hobbs Knutson, M.D., Blue Cross NC chief of behavioral health said Blue Premier Behavioral Health will expand access, improve coordination with primary care and help achieve better health outcomes.

The value-based reimbursement approach also will enable the two organizations to evaluate quality in mental health care as part of a larger value-based reimbursement healthcare approach.

Nearly one in four people in America experience a mental health condition, yet more than half don’t get the treatment or support they need.

A recent Milliman report found that it’s becoming more difficult for patients to find access to affordable mental health and substance use disorder treatment, both because of a shortage of mental health providers and because many don’t participate in health plan networks.

The collaboration marks a shift in the way that patients experience mental health, the way that mental health providers offer care, and the way that health insurers cover the cost of mental health services.

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Quartet said it's beginning this initiative with Blue Cross NC and will work with additional health plans to roll out value-based mental health care across the country.  

"Our technology will help people get the right mental health care for their needs, and allow mental health providers to be recognized and rewarded for improving patients’ health. This work acknowledges what we’ve long known: mental health care is health care," David Wennberg, M.D., CEO of Quartet, said in a statement.

The recent shift to an outcomes-based health care system has focused almost entirely on physical health, according to Quartet and Blue Cross NC. It's also difficult to track what good mental health care is, and the standard of care has never been consistently documented.

The HITECH Act of 2009 and ensuing Meaningful Use incentive payments created the technological framework and incentive structure for collecting and sharing data but many mental health providers, including therapists and social workers, have largely not been eligible for value-based payment programs. 

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“The only way to achieve true parity in mental health care is to make it easier for people to access high-quality care,” former Congressman Patrick J. Kennedy, founder of The Kennedy Forum, said. “The work that Quartet and Blue Cross Blue Shield of North Carolina are doing to offer value-based payments for providers is critical."

Quartet has developed a central technology platform that enables physicians, mental health providers and payers to coordinate care and drive down health costs. The company currently operates in seven states—Pennsylvania, Washington, California, New Jersey, North Carolina, Louisiana, and Illinois.

The company, founded in 2014, has raised a total of $160.5 million to date from investors including Oak HC/FT, GV (formerly Google Ventures), F-Prime Capital Partners and Polaris Partners.