At the Behavioral Health Tech (BHT2024) Conference in Phoenix, Arizona, Marissa Plescia from MedCity News sat down with Stephen Smith, Co-founder and CEO of NOCD, the industry’s leading OCD treatment provider for children, adolescents, and adults, along with key behavioral health and technology leaders from Cigna and Health Care Services Corporation (HCSC), to discuss how providing effective, specialized OCD treatment is one of the greatest opportunities for impact in the behavioral health industry today.
Recent large-scale studies have spotlighted the clinical and financial opportunity offered by better identifying and managing people with obsessive-compulsive disorder (OCD), one of the most stigmatized, costly, and treatable serious mental illnesses.
Historically, OCD—a chronic condition that affects 1 of 40 people at some point in their life—has been overlooked by health plans and managed behavioral health organizations as a key area of focus. Pervasive misdiagnosis and miscoding by in-network providers has prevented treatment-seeking people with OCD from getting properly managed for decades, generating staggering amounts of unnecessary behavioral and medical expense that’s been misattributed within payer claims to populations other than OCD. This effect has completely hidden OCD’s havoc from payers—in fact, research suggests 96% of people with OCD do not surface in claims data.
“Access to care is a big issue, but it’s really about the right access: access to the right provider to get treatment for the right diagnosis,” explains Dr. Doug Nemecek, MD, Chief Medical Officer at Evernorth Behavioral Health. “We want people who specialize in OCD to make sure that diagnosis is correct and consistently deliver evidence-based care. That's what's going to really drive clinical improvements.”
Because the condition is highly treatable with Exposure and Response Prevention (ERP) therapy, the break in claims has caused a tangible opportunity to drive clinical outcomes and curb significant costs within a meaningful segment of the population to go untapped, until now.
Cigna and HCSC both independently decided to analyze over three years of claims data from NOCD’s OCD-specialty therapist network. Through their analysis, they found similar results: a substantial cost savings opportunity exists by effectively identifying and managing their hidden OCD population with ERP therapy.
NOCD helped spotlight this savings opportunity. Once members from both plans engaged in NOCD’s content community, an online setting where stigmatized people with OCD feel comfortable seeking care, NOCD facilitated enrollment into NOCD Therapy, a fully virtual, evidence-based, ERP therapy service for OCD.
In total, the company enrolled thousands of previously unidentified, hard-to-reach, members with OCD and related conditions into NOCD Therapy between the two payers, using its unique community-connected therapy model.
The clinical outcomes were strong, similar to the results demonstrated by NOCD in several peer-reviewed papers, and they led to cost savings.
For instance, Cigna members who were managed in NOCD Therapy demonstrated:
They also generated substantial savings of approximately $250 per Cigna member per month. These results are striking, and they validate what OCD experts have known for decades: without specialized treatment, OCD has a devastating impact on all areas of life—including healthcare costs.
HCSC saw similarly significant clinical outcomes and cost savings in their own study. “We’ve had hundreds of people who have been treated at NOCD, and our team of data analysts modeled out the six months of healthcare expenses before working with NOCD, and the six months after they started treatment,” shares Frank Webster, MD, CMO of Behavioral Health at Health Care Service Corporation. “When they started treatment, expenses immediately dropped about $400 per month.”
There are a few reasons for this: firstly, OCD is rooted in intrusive thoughts, images, and urges that cause extreme fear and doubt, known as obsessions. To make their obsession go away and find certainty, people do specific actions called compulsions. The compulsions might offer short-term relief, but they make symptoms worse in the long run. When people’s obsessions involve health concerns, they often compulsively seek unnecessary screenings, treatments, and second or third opinions from medical providers to disprove their obsessive fear, significantly burdening the system.
Second, and perhaps even more common, is the financial consequence of ineffective or harmful care for people with OCD. For instance, mistreated OCD—often the result of misdiagnosis—can lead to comorbidities like substance use disorders, eating disorders, depression, anxiety, and even metabolic issues. When people with OCD develop severe comorbidities, they’re usually referred for more intensive treatment—this may mean anything from residential treatment for behavioral health issues to ER visits for medical complications. However, once they’re diagnosed with OCD, focused, evidence-based ERP therapy can address the root cause of these conditions, drive clinical outcomes, and curb substantial residential treatment utilization.
These results suggest that effectively serving the OCD population must be one of the top five priorities for every behavioral health executive. It’s rare to find tangible, untapped, opportunities to drive clinical outcomes and reduce benefits expense for such a large segment of the population.
Smith offers a succinct summary of what this means for the behavioral healthcare industry as a whole: “At scale, OCD treatment is actually one of the most tangible opportunities to make a major impact in behavioral healthcare. We just have to do a really strong job at identifying people with the condition early in their journey and scaling the right types of evidence-based treatment. And if we can do that consistently, our mental healthcare system will transform for the better.”
The large-scale studies conducted by Cigna and HCSC in partnership with NOCD shed light on a promising path forward for behavioral healthcare. Expanding overall access to care is an essential step toward ending the behavioral health crisis, but “one size fits all” therapy is insufficient. For managing more severe populations like OCD—where the potential for clinical and financial progress may be greatest—focusing on accurate diagnosis and specialized care is imperative.