Blue Cross VT Improves Access to Mental Health Services
To meet the increasing need for improved access to mental health and substance use disorder services, Blue Cross VT has removed prior authorization requirements for mental health and substance use disorder treatment for in-state, in-network facilities.
Berlin, Vermont — To meet the increasing need for improved access to mental health and substance use disorder services, Blue Cross and Blue Shield of Vermont (Blue Cross VT) has announced the removal of prior authorization requirements for mental health and substance use disorder treatment for in-state, in-network facilities. This prior authorization change is now in place for treatment programs across various levels of care, including inpatient, residential, partial hospital, and intensive outpatient programs. This move aligns with Blue Cross VT’s goal to improve Vermonters' access to mental health services.
“We come to work every day with a single-minded focus on improving access to high quality care,” says Dr. Tom Weigel, Chief Medical Officer of Blue Cross VT.
A board-certified clinical child psychiatrist, Dr. Weigel has challenged Blue Cross VT to think more creatively about improving Vermonters’ access to mental health services. Since joining Vermont’s only local health plan in 2021, he has encouraged his team to look both inside and outside of the confines of Vermont’s physical landscape to expand member access to mental health care.
Recently, the company announced a new partnership with Valera Health. This provider group supports Blue Cross VT members’ emotional wellness, including perinatal mental health, childhood and adolescent anxiety, OCD and depression, schizophrenia and follow up after hospitalization. Blue Cross VT members also have 24/7 access to Amwell, which provides urgent care advice, psychiatry services, consultations with board-certified doctors and prescriptions. Blue Cross VT offers plans with four in-person mental health visits before the member deductible kicks in, which is more than other health plans offered in Vermont.
That access to care no matter the hour of the day or night is critical to supporting Vermonters in crisis. During his time in middle school, Dr. Weigel's life was profoundly impacted by the suicide of a close friend. This pivotal tragedy propelled him towards a career in child and adolescent psychiatry. That focus carried through his work at the Vermont Department of Mental Health, and Dr. Weigel now uses a critical lens to examine health care policies at Blue Cross VT with the aim of improving access to care at a lower cost.
In addition to expanding access to telehealth mental health services, the changes to prior authorization for in-state, in-network mental health facilities are expected to have several positive impacts on Vermont’s health care system. By enabling easier access to lower levels of care, such as partial hospitalization or intensive outpatient programs, patients can receive appropriate treatment earlier, potentially preventing the need for more intensive and costly forms of care like inpatient or residential programs. This proactive approach not only improves patient outcomes but also helps contain health care costs by reducing the frequency and duration of higher-level treatments.
Ultimately, Blue Cross VT’s decision to remove prior authorizations aligns with the Quadruple Aim framework which improves the patient experience, enhances population health, reduces costs, and improves the work-life balance of health care providers. By facilitating easier access to mental health and substance use treatment and lowering provider administrative burden, this policy change is expected to contribute positively to all aspects of the Quadruple Aim, thereby benefitting both patients and the broader health care ecosystem.
“The data plays a significant role in our decision process about adding or removing prior authorizations, as do the heartbreaking stories of our neighbors who struggle with severe mental illness and substance use disorder,” says Dr. Weigel. “It is our hope that this change might also help to alleviate the severity of emergency room boarding times and make it easier for Vermonters in crisis to access stepped-down levels of care.”
Blue Cross and Blue Shield of Vermont is a local, not-for-profit health plan. For over 40 years, the company has been enhancing the health and well-being of the Vermonters we serve by offering innovative plans to individuals, older Vermonters, and businesses. Our employees are dedicated to developing new ways to support high-quality care, programs, and events that promote wellness.
