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Dear SUNCLOUD HEALTH,
Congratulations! Your facility has received the 2026 Evernorth® Behavioral Health (Evernorth) Center of Excellence (COE) designation for Mental Health - Child and Adolescent at the partial hospitalization and/or intensive outpatient program (PHP/IOP) levels of care based on your clinical quality and cost-efficiency measurements. This is a new designation, resulting from the expansion of the COE program for 2026 to include PHP/IOP.
This email explains the evaluation methodology used for the 2026 COE designation and provides the results for your facility. If your facility includes multiple locations under a single Taxpayer Identification Number (TIN), this message serves as the official notification of your designation status for all associated locations.
If your facility is designated as a COE for other types of services or levels of care, you will receive a separate email for each designation.
2026 PHP/IOP evaluation criteria
We assessed facilities that offer PHP/IOP levels of care using the following criteria:
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Seven-day ambulatory follow up: Percentage of patients seen by an in-network behavioral health care facility or licensed outpatient provider within seven days of discharge. |
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Escalation to higher level of care: Percentage of patients without admission to a higher level of care during the episode of care. |
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Readmission rates: Percentage of patients without readmissions within 60 calendar days of discharge. |
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Emergency department (ED) admissions: Percentage of patients without a behavioral admission to an ED within 30 calendar days of discharge. |
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Total number of annual admissions: A minimum of: 14 unique treatment episodes for adult mental health; 11 unique treatment episodes for child and adolescent mental health; 14 unique treatment episodes for substance use disorder; and 12 unique treatment episodes for eating disorders. |
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Total cost per episode: Total dollars paid for services based on regional cost standards, accounting for extreme outliers. |
Results
The quality score reflects a facility’s effectiveness in treating child and adolescent mental health disorders, evaluated at the national level to ensure consistency in care standards across all facilities using Evernorth’s clinical framework.
The cost-efficiency score measures the average treatment costs for child and adolescent mental health disorders based on a facility’s Evernorth fee schedule and average length-of-stay data. This measure is assessed at the regional level to account for geographic variations in pricing structures and reimbursement rates.
Facilities can earn up to three stars in each of two categories: Quality and cost efficiency. To receive the COE designation for Mental Health - Child and Adolescent at the PHP/IOP levels of care, a facility must earn at least five stars total, with a minimum of two stars in each category.
Your facility’s quality and cost-efficiency metric results are detailed below. Please note that the results may be representative of all clinic locations that bill under your TIN.
Quality results
+ Seven-day ambulatory follow up: 100.00%
+ Escalation to a higher level of care: 81.25%
+ Readmission rate: 75.00%
+ ED admission rate: 100.00%
Cost-efficiency results
+ Admissions: 16 unique customers
+ Average cost per admission: 10,732 (physician charges excluded)
Your COE designation now displays in the provider directory
Behavioral health COE locations have been updated in our online directories and identify SUNCLOUD HEALTH as a COE. Your COE designation will be evaluated annually.
Thank you for the quality care you provide to our customers. We value our relationship with you and welcome your feedback as we continue to refine the COE program. If you have questions about your evaluation, please email BEHprep@Evernorth.com
Sincerely,
Network Operations Management
Evernorth Behavioral Health, Inc.
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