How BCBS-MA Connects Mental Health Benefit Design, Employer Strategy, and Collaborative Care

Co-pay and cost-share waivers improve access as PCP specialist teamwork grows.

What stigma helped create, COVID-19 has made worse.

The crisis in question is mental health. Blue Cross Blue Shield of Massachusetts (BCBS-MA) is responding with employer benefits and integrated care delivery models designed to speed access, equity, and innovation.

“These are a few solutions we’re developing along with our account partners,” says dr Gregory Harris, BCBS-MA’s senior medical director of behavior health and an architect of the plan’s new offerings. “Employers want to think differently and so do we.”

The question that spans all benefit design changes is does this help reduce the barrier to access? Harris adds: “There are so many angles to look at: some within health plans, some across the mental health delivery system.” In an interview with HealthLeaders, Harris details BCBS-MA’s new mental health benefits and the psychiatric collaborative care management that anchors them.

Benefit updates, employer response, and member impact

BCBS-MA’s new employer designs are benefitting thousands of BCBS-MA members and include three offerings:

  1. Co-pay cost-share waivers. Employers can offer the waiver for an employee’s first one, three, or six visits for mental health/substance use disorder. Twenty-one employers have signed on, impacting more than 38,000 members.
  2. Medication cost-share waivers. Employers can offer $0 co-pays for multiple prescription drugs; 10 customers are providing the mental health medication benefit for 27,000 members. Six employers have signed up for the substance-abuse medication benefit, affecting more than 18,000 members.
  3. Wellness incentives. In a single month, 28 employers began offering a $300 reimbursement for employees who participate in programs, classes, and apps for stress reduction and relaxation. More than 93,000 members can benefit.

The decision-making process

Harris worked with account teams to execute a process that is giving employers more options:

  • Internal pilot beginnings. BCBS-MA offered enhanced benefits internally first. Approximately 3,800 employees have the waived co-pays for select depression/anxiety medications.
  • Clinical and account team collaboration. Before expanding to employers, Harris and BCBS-MA account leads collaborated to design benefits that expand access.
  • employer engagement. While employee mental health is top of mind for most employers, some companies are more involved. “They are looking for the next inflection point,” says Harris. “We discuss uptake, results, and decisions to create a product for them and to continue expanding.”
  • Evaluation and next steps. Harris states that the plan is making decisions for 2023. “We’re looking at what course of treatment looks like after the 1-3-6 visit approach gets patients in the door.” BCBS-MA may also differentiate design between children and adults.

Learning from each other

Harris is equally invested in what he brings to BCBS-MA and what its teams have taught him. The practicing psychiatrist is charged with shaping and operationalizing the plan’s mental health strategy with internal associates, customers, and clinical partners. Harris offers ongoing mental health chats, presentations, and interactive Q&A sessions across the organization.

“I came to BCBS-MA grounded in what patients and clinicians need and want, but not as familiar with what employers are looking for,” says Harris. “Now, thanks to my work with our account teams, I’m also skilled at designing employer programs.”

He adds: “I’ve spent a lot of my time working to align the needs and incentives for all parties, including patients, employer accounts, clinicians, and the health plan. I try to offer clinical options that will meet the needs of the employer and the member.”

Layering collaborative care for added benefit

Part of what Harris adds is a focus on psychiatric collaborative care management. The model creates tighter bonds between primary care and mental health specialty care. The desired result? Faster screening, earlier consultation and referral, and the billing education and incentives PCPs need to integrate the model.

Harris notes that psychiatric CCM is an evidence-based model developed by the University of Washington and embraced by the American Psychiatric Association.

Harris emphasizes that CCM adds the right kind of layers to the delivery system, from patients to providers.

“In Massachusetts, you can refer to a psychiatrist or therapist yourself. You don’t have to go through a PCP, but the unintended consequences are that you’re on your own in a system of solo practitioners,” says Harris.

“CCM knits things back,” he adds, noting that in a fragmented system, it’s important to get more done in primary care. “CCM helps connect the dots. Integrating mental health specialty care into primary care is a good 10 years behind other models.”

“So many aspects are a supply and demand crisis. Many people are untreated and not thinking of options like their PCP. It’s not a good layering of the system, which must meet mild, moderate, and severe need in a better way.”

For Harris, it’s a reminder of interests that date back to his professional beginnings.

“I started my career with the idea of ​​putting mental health care into primary care,” he says. “I always try to keep the patient at the center of everything I do.”

Laura Beerman is a contributing writer for HealthLeaders.

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