Patients in North Carolina face a significant barrier to getting mental health care services: a shortage of behavioral health specialists. North Carolina ranks 38th in access to mental health care, according to Mental Health America, and 61 of the state’s 100 counties have no psychiatrists treating children and adolescents.
In its latest effort to address critical mental health needs in the state, Blue Cross and Blue Shield of North Carolina is tapping a fast-growing mental health startup to help expand its network of behavioral health providers.
Through a partnership with Headway, Blue Cross NC is particularly focused on addressing access issues in underserved communities, including rural and socially vulnerable areas, and expanding mental health care for children, adolescents and individuals across diverse racial and ethnic backgrounds.
The collaboration will make it easier for Blue Cross NC members to quickly access—as soon as within 48 hours—in-network therapists and psychiatrists who meet their specific needs, according to the organizations.
Headway aims to build a new mental health care system in the U.S. to make it easier both for patients to find a therapist and for therapists to accept insurance, according to Headway CEO and co-founder Andrew Adams.
"We started with building our network of providers on a common infrastructure to solve all the barriers that typically exist and stymie access for providers, patients and health plans," he told Fierce Healthcare.
Headway developed a full-stack therapy marketplace that deals with the messiness of insurance, building out a first-of-its-kind behavioral health network of therapists who accept insurance.
The statewide collaboration, which is available to about 2.2 million of the insurer's members, will enable patients to quickly access in-network therapists and psychiatrists who meet their specific needs and preferences.
"What I love about Headway is that they solve two problems at the same time," Nora Dennis, M.D., lead medical director of behavioral health and health equity at Blue Cross NC, told Fierce Healthcare.
"We have challenges around access, and there's a big piece of that challenge that stems from independent behavioral health providers being able to accept insurance payments. There are a lot of providers who would like to be in that work but find the administrative processes challenging. Headway is making it easier for those providers to take insurance, which I think is great. At the same time, they have a really accessible online platform for our members to help them find a provider who's going to be a good fit for them," she said.
She added, "They also were very willing to work with us to specifically think about our members who are in more socially vulnerable counties and our pediatric members and try to put the focus on them. Equity and pediatric behavioral health are both a huge priority for us. It was exciting to find a provider who had an interest in those topics as we do."
Under this agreement, Blue Cross NC will enter into a value-based arrangement to ensure strategic alignment and close collaboration between the two organizations to enhance member access, experience and outcomes.
Since launching in 2019, New York City-based Headway reports that more than 15,000 credentialed mental health providers have delivered care through Headway, which currently operates in 14 states and the District of Columbia. The company has facilitates 2.5 million appointments a year, Adams said.
Through the partnership, the two organizations will focus on expanding access to care for children and adolescents, who often need providers specializing in meeting their clinical needs. Nearly 52% of North Carolina youth with major depression do not receive any mental health treatment, according to Mental Health America.
Headway also will help the insurer recruit and enable child and adolescent specialists to further meet needs across the state.
The initiative is already underway, having launched in May, and the organizations are reporting positive results to date, with speed to care averaging 5.4 days and nearly 10,000 appointment openings in the next two weeks.
The two companies also will identify, credential and support clinicians who practice in rural regions of the state. Headway will work with Blue Cross NC to recruit providers across race, ethnicity, language and gender to meet member needs.
"We're also addressing digital equity. Some of our members who are in more rural areas, their availability to use audio or visual telehealth can be limited as well. Headway does connect folks with providers who can do in-person visits, which I think is important," Dennis said.
Headway enables members to find a mental health clinician that fits their needs and preferences, across clinical specialty, location, virtual or in-person, personality, and race, language, and ethnicity.
While expanding access helps to address equity, it's also important to "dig deeper" and look at the diversity of the provider pool, Dennis said. Headway's technology allows members to have more options when selecting a provider.
"For our members who are really often at the intersection of different minoritized communities, it is so important for them to be able to have a lot of information about the provider they're going to be seeing. That's a huge advantage sometimes that these companies have over what I would call business as usual," she said.
The best serve the needs of patients across diverse racial and ethnic backgrounds, it's important to build out a diverse provider network. In North Carolina, Headway's network is 43% nonwhite, compared to the state's racial makeup with 40% of the population being nonwhite, according to the state census. Nationally, Headway's provider network is nearly 50% nonwhite.
"We would certainly consider ourselves to be innovators and to be leaders with respect to health equity," said Dennis, who has worked with the insurer for a year and a half. "I think one of the great opportunities that we see in working with newer companies is that there is an openness to looking at different ways of driving equity in terms of access and outcomes. There's an openness to really transparent reporting around equity. And there's an openness to accountability around equity, and to me, that's really sort of the frontier from the payer perspective. I'm excited to be working with Headway to kind of push the boundary there."
Headway's model also enables the company to partner with payers on a value-based care model.
"We have an opportunity because we're a single network on a single infrastructure to measure things in a way that they haven't been measured and actually deliver on them at scale in a way where it wouldn't have typically been possible with individual 'mom and pop' providers," Adams said.
Measuring the quality of care from its provider network, Headway reports that patients see a 35% reduction in PHQ-9 scores, a tool used to screen, diagnose and measure the severity of depression. "We deliver on that quality of care because we're building that single network on a single infrastructure to measure these sorts of things," Adams said.
Adams co-founded Headway to address accessibility and affordability issues for mental health care services. An estimated 26% of Americans ages 18 and older—about 1 in 4 adults—suffer from a diagnosable mental disorder in a given year, according to Johns Hopkins Medicine.
The main barrier to affordable care is that almost 70% of therapists do not accept insurance because of the administrative burden and the time commitment required, especially for the 85% of therapists who are solo practitioners.
The company's platform lets its users find therapists who match their preferences and book directly on the site and provides transparency about what they'll owe with their in-network insurance plan.
For therapists, the company handles the full process to join an insurance panel and offers free software with full claim management support, payments and scheduling.
The startup, which is backed by Andreessen Horowitz, Accel, Thrive Capital, and GV (formerly Google Ventures), has raised $100 million to date, including a $70 million series B round in May 2021 that boosted its valuation to $750 million.