Polishing my behavioral health crystal ball, here are 4 emerging trends offering opportunities for life science companies in 2024.
An Overarching Theme: Simplify Complexity and Resolve Problems
An overarching theme throughout the health care ecosystem—including behavioral health—is that within a landscape fraught with post-pandemic and economic transitional uncertainty, patients and their care partners expect health care stakeholders to simplify complexity, help manage risks, and solve their problems. A 2023 Bain survey, and an NEJM article, “Health Care 2030: The Coming Transformation,” are calling for the abandonment of traditional perspectives, and adoption of transformative mindsets and systems focused on providing solutions and offering personalized, preventive care for populations. Patients and caregivers are expecting streamlined insurance navigation, anticipation, prevention of their health care problems, and help with chronic and life-threatening conditions. They’re seeking engagement through digital solutions, with easy access to empathic humans to solve their more complex issues and help them live healthier lives. This is particularly noteworthy for manufacturers offering behavioral health solutions, given the complexity of behavioral health conditions, often co-occurring with chronic medical conditions.
Those who deliver better experiences and outcomes will be the recipients of increased brand loyalty. These expectations can be daunting, and it’s therefore not surprising that a 2023 PRECISIONvalue survey of health systems and health plans found that most respondents are collaborating (or willing to) with manufacturers on an array of population health management (PHM) activities, including collaborations on quality measure performance, which strongly influences plans’ and systems’ PHM priorities.1,2,3 We’ll next discuss 3 additional, related trends.
Behavioral Health Outcomes Quality Measures Linked to Value-based Reimbursement
Outcomes measures are increasingly prevalent throughout the health care ecosystem, including within behavioral health. For example, the National Committee for Quality Assurance (NCQA) is phasing in public reporting on additional behavioral health electronic clinical quality measures, one of which, “Depression Remission or Response for Adolescents and Adults (DRR-E),” measures (using the PHQ-9) response to treatment for depression 4–8 months after an initial elevated score on that same standardized depression screening tool.4.
CMS’ Quality Payment Program: Pathways to Outcomes-based Reimbursement
CMS’ Quality Payment Program, a Medicare value-based reimbursement program with 600K+ clinicians serving 55M+ beneficiaries,] uses several reporting and payment options, including the Merit-Based Incentive Payment System (MIPS), to adjust provider payments negatively or positively based primarily on quality and cost metric performance.5 Clinicians now have 3 reporting options within MIPS: MIPS Value Pathways (MVPs), traditional MIPS, and the APM Performance Pathway (APP). CMS intends to sunset traditional MIPS in an unspecified future year, which will then require MIPS clinicians to report through the MVP or APP pathways.6
MIPS Value Pathways: A Pathway to Behavioral Health Outcomes-based Reimbursement
Recently, CMS finalized the first behavioral health MVP, “Quality Care in Mental Health and Substance Use Disorders MVP,” available to MIPS-eligible practitioners including those in mental/behavioral health, psychiatry, clinical social work, nurse practitioners, and physician assistants. The presently optional program begins in 2024 with payment in 2026 based on 2024 performance. In this MVP, payment will be adjusted positively or negatively based on performance on outcomes such as spending on cost measures pertinent to depression, psychoses, and related conditions; and population health measures such as all-cause hospital readmissions and hospital admission rates for patients with chronic conditions. Participants will have an additional array of quality measures to report on, at least one of which must be an outcome measure. This value pathway includes outcomes measures pertinent to depression, schizophrenia medication adherence, anxiety, PTSD, substance use, and suicidality, for which participants may elect to report their performance.7
Value-based payment programs and quality measures developed by CMS often provide a framework for other payers to adopt and adapt, to incentivize delivery of effective care for patients. Life science leaders should monitor developments in this landscape and offer tools and training to support payer and provider performance on relevant measures.
Increased Accountability will Drive Delivery and Demonstration of Better Solutions
As clinician and plan accountability for performance on behavioral health outcomes measures is increasingly linked to financial incentives, acceleration of interventions, including combination interventions will expand. Opportunities will exist for manufacturers to support initiatives such as:
- Use of underutilized therapies, such as adjunctive atypical antipsychotics with patients not experiencing full remission from depression, or use of long-acting injectable medications for patients with schizophrenia or bipolar-1 disorder, to support their adherence and functioning
- Digital and telehealth solutions for better adherence and clinical outcomes
- Mitigation of adverse social determinants of health (SDOH) presenting therapeutic barriers and contributing to sub-optimal clinical outcomes and quality measure performance
- Demonstration that products and interventions contribute to better outcomes pertinent to behavioral and medical conditions, embracing a “whole person” approach
Reducing Health Disparities
NCQA, The Joint Commission, and URAC are launching additional quality measures and accreditation standards to help assess and address SDOH, the identification of health disparities among sub-populations, and monitor the results of continuous quality improvement programs to close health disparity gaps for better PHM outcomes. This will provide impetus for manufacturers to demonstrate that their products, from clinical trials through commercialization, provide value for diverse populations, and remove barriers to support inclusive access and adherence with innovations. Further, it will provide opportunities for manufacturers to collaborate with payers, patients, and practitioners to close disparities, for example, on maternal health outcomes, including postpartum depression screening and care.
This article concludes where it began: Patients and caregivers are looking to the health care ecosystem to simplify complexity and offer streamlined solutions for healthier lives. Payers and providers are willing to collaborate on population health solutions. In 2024, manufacturers who engage their patient, payer, and provider customers with streamlined, inclusive, and collaborative solutions demonstrating stronger outcomes will reap the rewards of superior customer loyalty.
- Naujoks H. Customer Behavior and Loyalty in Insurance. Global Edition 2023. Bain and Company. February 16, 2023.
- Zimlichman E, Nicklin W, Aggarwal R, Bates DW. Health Care 2030: The Coming Transformation, Catalyst, Innovations in Care Delivery. NEJM. 2021; 3.3.
- PRECISIONvalue Population Health Management Survey. Proprietary survey, 2023.
- Depression Remission or Response for Adolescents and Adults (DRR). NCQA.org. https://www.ncqa.org/hedis/measures/depression-remission-or-response-for-adolescents-and-adults/
- Centers for Medicare & Medicaid Services. The Quality Payment Program. CMS.gov. October 25, 2016. https://www.cms.gov/newsroom/fact-sheets/quality-payment-program
- Quality Payment Program. MIPS Value Pathways (MVPs). QPP.CMS.gov. https://qpp.cms.gov/mips/mips-value-pathways
- Centers for Medicare & Medicaid Services. 2024 QPP Final Rule MVP Guide. Quality Payment Program. Resource Library. QPP.CMS.gov. https://qpp.cms.gov/about/resource-library