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  • Writer's pictureMuhammad Sair Khan

Payer Desire for Value-Based Reimbursements

Insurance companies are working to find new ways to reimburse for behavioral health care, in order to ensure the money being paid is going towards quality care. Payors are now trending toward value-based reimbursements that reimburse for care based on patient outcomes data. While companies have yet to find a workable model, this trend is unlikely to go away. Over the next few years, it’s likely that more insurance companies will design and adopt value-based reimbursement.

To prepare your facility for these changes in reimbursement, it’s important to understand what’s happening now. Learn more about how insurance companies are becoming involved in behavioral health care below.


Optum has begun working with behavioral health providers across the country to create “recovery-oriented” behavioral health programs. These programs focus on achieving positive patient outcomes by using effective, evidence-based treatment plans, and by engaging individuals, their families, and their communities as stakeholders in the patient’s recovery.

Throughout the country, Optum has partnered with healthcare providers, local governments, and communities to increase access to vital resources such as:

  • Peer support to keep patients on the road to recovery

  • Field care advocates (social workers, for example, who are able to help patients access treatment as well as other resources they may need)

  • Programs to help people with mental illness spend less time incarcerated, and have access to resources they need when they are released.

These pilot programs throughout the U.S. may play a larger role in behavioral health care in years to come.


Cigna is focusing their efforts on preventing opioid abuse and misuse by partnering with pharmacists, physicians, and other professionals. By using data, technology, and patient assessments, they can see which patients are currently prescribed opioids, and determine which of those patients may be at a higher risk of misusing their prescribed drugs . They can then alert providers whose prescribing practices may put patients at a higher risk of substance abuse.

Their program also helps providers find alternative pain management plans that don’t involve the use of opioids. These plans may involve over-the-phone cognitive behavioral therapy to help deal with pain or referral to pain management providers who known to provide quality care.

While these programs focus on prevention, Cigna also provides support to patients who are already suffering with a substance use disorder. This support may include care coordination, education for patients and families, as well as referrals to trusted physicians.

Blue Cross Blue Shield

Blue Cross Blue Shield is piloting many different substance abuse programs in different states across the country. In Michigan, for example, they are helping ensure patients are able to receive medication-assisted treatment for at least two years, as well as behavioral health counseling. They also have instituted Naloxone training in Massachusetts, and are utilizing prescription monitoring programs to identify patients who may be abusing opioids.

By understanding what each insurer is doing to improve behavioral health care, you can begin taking the same steps at your facility. For instance, you may want to develop a medication-assisted treatment program or family support groups. You may want to begin offering long-term care coordination and/or follow-ups for patients or programs designed for people who have been incarcerated. If insurance companies are offering these programs, it’s likely they will offer greater reimbursement for facilities utilizing these programs in the future.

At Datapro billing, we stay on top of the latest changes in reimbursement and help our clients ensure they are ready for the future. Find out how we can help you navigate the future of behavioral health care payment. Schedule a complimentary 15-minute consultation by calling 805-579-3537 or contacting us online.

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