LAS VEGAS—As the team at Cigna's Evernorth builds its strategy around behavioral health, it's focusing on a key throughline: simplicity.
Accessing behavioral health care can be daunting, and that hurdle can prevent needs from being identified before they snowball, Doug Nemecek, M.D., chief medical officer for behavioral health at Evernorth, told Fierce Healthcare in an interview at AHIP's 2022 conference.
And, once a patient does decide to seek care, wait times and accessing providers represent other major barriers, he said. So Evernorth is aiming to harness all of the resources under its broad umbrella—which includes telehealth, data analytics and a massive pharmacy benefit manager in Express Scripts—to ease those barriers across the patient's care journey.
"What we're doing is focusing on, 'How do we make the behavioral health journey for individuals simple, predictable and easy?'" he said. "Too often, behavioral health seems too hard and complicated."
An example of this at work, he said, is harnessing claims data through its analytics arms to identify a child who is likely to be diagnosed with autism. By flagging those risk factors sooner, the family can get the child into appropriate autism care services more quickly.
Looping in the pharmacy side of the house also represents a tremendous opportunity, Nemecek said. For a number of people struggling with depression or other mental health conditions, the only trigger in their medical records may be a prescription from a primary care provider for an antidepressant.
Seeing that on their record, even if they don't have a formal diagnosis for a mental health condition, can also open the door to helping a patient get into a behavioral health treatment program, he said.
"It starts at the beginning because of the breadth of resources and data we have at our fingertips at Evernorth," Nemecek said.
Evernorth is also the parent company for MDLive, a telehealth platform with the potential to reach millions of people. Telehealth use, particularly for behavioral health, has grown exponentially under COVID-19.
Nemecek said the digital piece is critical to offering a behavioral health care experience that is simple and convenient for the patient. It allows them to see clinicians on their own time and in a venue that may be more comfortable for them than an in-person visit.
He said providers expect high no-show rates in behavioral health, and with digital platforms they're seeing far fewer patients skipping out on appointments.
It can also offer a lifeline to people who may not be able to find a provider near them, he said. Behavioral health has struggled with provider shortages, and coverage is often spotty, particularly in more rural or remote regions.
"I think the convenience of digital, the privacy of digital … really allows people to engage when and how it works for them," he said.
With all of these options in play, the challenge is now to synthesize these tools into a program that works for patients, employers and plan sponsors. Nemecek said that one of the concerns from employers is getting people into a program once it's designed and made available.
That requires both regular communication with the employee about what they can access and also being available when the employee is seeking help, he said.
An evolving area of interest is looking at behavioral health benefits and solutions beyond the individual worker, he said, as the mental health of their family members can also have a significant impact on their work productivity and wellness. This can be especially true for a parent whose child is dealing with mental health challenges, according to Cigna data released earlier this year.
"They really are looking at this, and we’re creating more programs to make sure we can support families to meet the needs of their children and dependents," Nemecek said.