A VBC Approach to Improving Pediatric Behavioral Healthcare Access

CareFirst BlueCross BlueShield (CareFirst), a health insurer serving the mid-Atlantic region, received reports from pediatricians who felt ill-equipped to offer comprehensive mental healthcare to patients with serious conditions. While many providers were able to handle mild cases of depression or anxiety, the more extreme scenarios stretched beyond their licensure. Moreover, they struggled to know where to refer patients for behavioral healthcare.Brian Wheeler, executive vice president of health services at CareFirst, told HealthPayerIntelligence that the payer’s first step was to partner with Children’s National Hospital (Children’s National), a pediatric hospital located in the nation’s capital. The partnership was under an accountable care organization model, an environment conducive to value-based care solutions like the one CareFirst planned to pursue.The second step was to partner the health plan’s independent behavioral health practitioners with a managed services organization.