Brightside Health expanding Medicare and Medicaid telemental health access

Brightside Health will be entering into new and expanded payer partnerships to support telemental healthcare access through Medicare and Medicaid, teaming with companies such as Blue Shield of California, CareOregon and Centene.

The news comes just months after the company – which serves individuals with mild-to-severe clinical depression, anxiety and other mood disorders – shared that it would begin serving 50 million Medicaid and Medicare beneficiaries.

These populations will have access to all of Brightside Health’s mental healthcare services; this includes psychiatry, therapy, and its Crisis Care program for people with elevated suicide risk, which has demonstrated positive results in its first year.

WHAT’S THE IMPACT

The partnerships include a new contract with CareOregon to serve Medicaid; a new contract with Blue Shield of California to serve Medicare Advantage; an expanded contract with Blue Cross and Blue Shield of Texas to include Medicare Advantage; an expanded contract with traditional Medicare to include Texas, California, Delaware, Arizona, New York, Washington, Florida, North Carolina, Michigan and Illinois; and an agreement with Centene to expand state-by-state, including Nebraska Total Care Medicaid and Wellcare Medicare Advantage.

A recent study in Psychiatry Research indicated that the prevalence of suicidal ideation and suicide attempts were statistically significantly higher among Medicaid recipients than privately insured individuals. 

Among the 65 million Americans enrolled in Medicare, the Centers for Medicare and Medicaid Services reported that 25% experience mental illness, which Brightside pointed to as suggesting a need to provide quality mental healthcare to those populations.

In October Brightside said it was teaming with Optum and other healthcare organizations to offer telehealth-based mental healthcare to Medicare and Medicaid beneficiaries, which the company said would enable it to provide in-network mental health services to 50 million more people, bringing its total covered lives to more than 100 million.

THE LARGER TREND

Last year, Bright Health announced it was selling its California Medicare Advantage business to Molina Healthcare, with proceeds meant to strengthen Bright Health’s capital position and to satisfy its obligations to its bank lenders. The remaining funds would be used toward liabilities in its discontinued Affordable Care Act insurance business. The company also announced it had extended a waiver and amendment to its credit facility.

Molina amended the purchase agreement in December. The purchase price for the transaction, net of certain tax benefits, is reduced from the previously announced $510 million to approximately $425 million, and now represents 23% of expected 2023 premium revenue of $1.8 billion.

Bright Health is not alone in facing financial challenges. Other insurtechs such as Oscar Health and Clover Health were trading at far less than what they were when they went public, according to a June article in the The Wall Street Journal. This is despite the promise of AI helping to upend the insurance business.

Oscar Health’s stock has been rising since October 2023, according to Seeking Alpha. Clover Health’s stock peaked in August 2023. Managed care stocks have taken a hit due to spikes in utilization of medical care.

The business of health insurance, and how people pay for it, hasn’t fundamentally changed, WSJ said, making it tough for startups to flourish at scale.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.