Removing Intermediaries Between Providers and Consumers of Care

Disintermediation means getting rid of the middleman. In healthcare this typically involves removing intermediaries between the providers and consumers of care. This disrupts the status quo, and such disruption is currently being proposed by companies with new technologies. The proposed innovation involves not just technology, but a reconfiguration of healthcare. How might our field join in?

Headlines trumpet financing deals in behavioral healthcare every day. Analysts report that 149 mergers and acquisitions closed in 2021, a 34% increase over the record-setting year in 2020. This includes activity in mental health services, addiction treatment, and the autism and I/DD space. The new sector of digital therapeutics is growing with some new companies achieving multi-billion-dollar valuations.

Our field has long been underfinanced, and so this is good news. Awareness of behavioral health has never been higher. A proliferation of stories highlighting stigma suggests a potential torrent of pent-up demand. Investors quickly realized that insurance parity guarantees stable, long-term funding for services. Yet our industry must also keep an eye on what is driving changes throughout healthcare.

Our business consolidation pales beside the mega-mergers in general healthcare. For example, Aetna and CVS are one, and United Health employs more physicians than any US company. Yet the big M&A deals could obscure a new type of competition that is emerging. Healthcare technology is spearheading much of that competition with more to offer than new devices. It is offering new alliances.

These alliances start with a key reality: Many people do not like health plans. Their 2 most visible products, provider networks and claims processing systems, are unpopular. Access to networks has limitations and complications people dislike. Claims processing exemplifies how the cost of care is unnecessarily opaque and frequently capricious. Innovators are seizing on this longstanding animosity.

Consider the strategy outlined by Glen Tullman. His success with Livongo and Transcarent makes him one of today’s top healthcare entrepreneurs, and his focus is on removing health plans from the middle of the healthcare relationship. He dismisses health plans as creating “noise” and wants to silence them by promoting patient choice, easy care access, and lower cost.

His models are Uber and AirBnb. They directly connect passenger with driver and renter with owner. Tullman shows how health plans can be disintermediated by going directly to self-insured employers. This enables him to directly connect patient with provider. His company contracts with health systems and their associated doctors and facilities, and he hopes to make health plans passé.

Our field has taken several steps to disintermediate. Start-up companies began digitizing behavioral content a decade ago. For example, Livongo acquired the digital behavioral company myStrength (a company for which I consulted) to address behavioral health and medical-behavioral comorbidity. Research shows digital tools to be effective without intermediaries. Yet much more is possible.

Certain reforms start by focusing on the payer, and a few behavioral startups began to explore direct contracting with employers for outpatient services. New companies like Lyra Health were driven to fix our broken system for access to care. They have succeeded in contracting with numerous employers to directly connect patients and behavioral clinicians.

The focus throughout healthcare is increasingly on flexibility in care access. This includes face-to-face visits, virtual contact via video, voice or text, and purely digital therapeutic tools. What is the future of in-person care? Companies like LifeStance Health have been acquiring behavioral group practices in the belief such groups offer better access and quality. Group practices are the norm in medical care.

What is striking about these new behavioral health companies is that their innovative ideas are not new. Digital content has been offered for decades, but the technology is better now and the markets ready. Group practices have been waxing and waning in behavioral healthcare for generations. Various solutions to access have a long history. What is uniquely hopeful today?

Everyone wants behavioral capabilities in their healthcare system. Some may see how pervasive and devastating behavioral conditions can be, while others may just care about checking the box for having our services contracted. Nonetheless, this is our leverage for greater negotiating power. It has an expiration date, and so we should move with some urgency.

Technology enables solutions. It is rarely the real story by itself. The essential narrative of our field is access. We need to attract people to care and lower stigma. A part of that solution is helping patients where they are—in primary care. When therapists are working there routinely without the need for referrals, therapeutic alliances will be easy and stigma-free. The setting can facilitate disintermediation.

Intermediaries can be removed through contracting, technology, or the service setting. While many factors contribute to the access problems in our field, having too many people and too many steps is an access barrier for many. Behavioral healthcare is too complicated today. Let us disintermediate.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as President at ValueOptions and Chief Clinical Officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.