Region’s first value-based arrangement for behavioral health care hits milestone, surpasses $500,000 in quality payments rewarded to behavioral health partners

Buffalo, N.Y. (July 11, 2023) — Highmark Blue Cross Blue Shield, the region’s first health plan to establish a value-based arrangement for behavioral health care, reached a major milestone, surpassing $500,000 in quality payments rewarded to health care providers since it entered the arrangement with Value Network IPA, LLC in December 2019.

Value-based payment plans offer additional incentives, on top of traditional reimbursement, to providers for the quality of care they provide to their patients. This type of payment arrangement has proven to improve health outcomes for individuals and communities. Cost reductions for high-risk members treated were significant during the period studied, ranging as high as 45 percent per member per month for Commercial and Medicare patients.

Through its partnership, Value Network and Highmark Blue Cross Blue Shield also realized a significant reduction in inpatient hospital and emergency room utilization. This also means reduced medical expenses for its members receiving behavioral health care services, including those being treated for substance use disorder. 

“At Highmark Blue Cross Blue Shield, we have long valued our local behavioral health professionals, and understand that the care they provide to our members is critical in achieving total health,” said Dr. Michael Edbauer, president, Highmark Blue Cross Blue Shield of Western New York. “We view our arrangement with Value Network as much more than a contract, and because of the collaborative nature of our partnership, we’ve been able to make a real impact on the behavioral health community— patients and providers included.” 

Value Network is a robust behavioral health care collaborative and independent practice association that enhances quality care through clinical integration, aligned financial incentives, the use of community-based recovery support services, and the collection and analysis of quality and service data to improve behavioral and physical health outcomes. Founding partners include BestSelf Behavioral Health, Endeavor Health Services, Horizon Health Services, and Spectrum Health and Human Services.

“Partnering with Highmark Blue Cross Blue Shield has been instrumental in the success of Value Network. With innovative leadership, Highmark believed in the potential benefits of working together with Value Network. Their belief in us, and our Network, has since sparked other partnerships and value-based contracts with other health plans in the region,” said Andrea J. Wanat, CEO, Value Network.

Value Network, with its founding partner organizations recently introduced a pilot program to improve outcomes for a cohort of complex behavioral health and medically high-risk patients. Through this program alone, Highmark and Value Network have seen a 24.7 percent reduction in costs per member per month for commercial members and a 45.9 percent decrease in costs per member per month for Medicare members.

“Working together on common goals with Highmark Blue Cross Blue Shield helped develop the coordination among systems, and shared purpose among the people in those systems to create the change needed,” said Elizabeth L. Mauro, CEO, Endeavor Health Services. “Partnering with Value Network and recognizing the importance of behavioral health to overall health, led to improved health outcomes and experiences of care for people. We are proud of this work and look forward to doing even more together.”

Highmark Blue Cross Blue Shield has been a leader in raising awareness, investing in initiatives that enhance access to behavioral health services, and supporting innovative treatment approaches for mental health and substance use disorder over the past decade. Most recently, the health plan partnered with Mental Health Advocates and several behavioral health providers to develop #weareHOPE, a collaborative effort to address the mental health needs of the community following multiple traumatic events in Buffalo. This included several community events, and a mental health resource guide. Other partners included Spectrum Health Buffalo H.O.P.E program, Buffalo Urban League Buffalo H.O.P.E program, Hope Rises, Horizon Health Services, BestSelf Behavioral Health and the New York State Office of Mental Health. 

Behavioral Health is one of Highmark Blue Cross Blue Shield’s key focus areas for its health-focused grant program, Blue Fund. Since 2018, Highmark Blue Cross Blue Shield has awarded major grants to support many of Value Network’s partner agencies, including Crisis Services, Spectrum Health and Human Services, Harmonia Collaborative Care, BestSelf Behavioral Health, Endeavor Health Services, Buffalo MATTERS, Save the Michaels’ Court Treatment Program, Horizon’s Family Training Center at Horizon Village, Compeer Maryvale Leaders, and Directions: A Mobile Behavioral Health Project.

The local health plan also made a $1 million investment in Erie County Medical Center’s (ECMC) Trauma Center/Emergency Department project to support behavioral health and detoxification services.