National health plan Aetna will reduce the rates it pays therapists via the digital therapy enablement platform Alma.
The changes go into effect on July 15. Aetna is flattening higher rates for specific procedures and billing codes that include enhancements. It’s not yet clear if Aetna’s new billing strategy will impact other behavioral health providers. Representatives of Aetna have not yet responded to a request for comment. Representatives of other digital therapy enablement platforms have also not yet responded to a request for comment. This story may be updated.
On May 20, Alma informed providers that Aetna would make the following changes:
— It will pay the same rate for a 53+-minute-long session as it does for 37-to-52-minute sessions.
— It will pay the same rate for evaluation and management visits that are for highly complex patients as for moderately complex patients.
— Reimbursement for these evaluations and management visits by doctoral-level providers will be lowered to the rate paid to master’s-level providers.
“We disagree with these changes,” Alma said in its notice to providers. “We recognize the disruption this change may cause to your practice, particularly when you determine that extended time is clinically appropriate for a client.”
Spring Health, a B2B-focused mental health provider, acquired Alma on May 1.
The company also asks clinicians to provide feedback on how these changes will impact their work and detail their experiences under the current paradigm. It plans to share the findings with Aetna.
While Aetna has not responded to BHB’s questions on the topic, many providers wonder this type of rate change at Aetna will be extended across its entire outpatient mental health network, across just the many digital therapy enablement platforms — Alma, Rula Health, Headway, Grow Therapy, SonderMind, etc. — or will only remain applied to Alma-Aetna providers.
Generally, these types of digital therapy enablement platforms seek to bridge the many chasms between health plans, patients, and therapists. During the rise of these platforms, it was common to see them command higher rates than traditional providers because they were able to provide payers access to more in-network therapists provide tech services to therapists that enabled them to work in-network, and provide patients easier discovery, matching and access to therapists — especially via telehealth services. They also enable therapists to operate on a cash basis or otherwise collect fees from patients. These types of businesses are among the busiest in credit card spending.
These types of rate changes challenge providers’ ability and interest to continue seeing patients through a specific contract. This change presents a “double whammy” for doctorate-level providers who see complex patients. About 62% of psychologists are in-network with any health plan, according to a survey by the American Psychological Association. Other research finds about 35% of therapists do not accept insurance.