It’s Time for Health Plans to Hold Behavioral Health Providers Accountable for Outcomes

For too long, the behavioral health industry has treated accountability and transparency as burdens rather than tools for delivering better care. This lack of responsibility has harmed the 57M+ Americans living with mental illness and has left health plans without reliable partners to drive meaningful improvements. It’s time not only for providers to step up — but for health plans to demand better.

As founders of next-generation behavioral health provider organizations, we believe that accountability is fundamental to fixing a system that too often fails patients. We were both driven to start our respective organizations because the status quo system has consistently failed to provide the care Americans need, including for the people we love. We’ve embraced measurement-based care (MBC) and value-based models to ensure care is more than just accessible — it’s care that actually works. And while many providers have resisted these standards, we view them as non-negotiable in delivering on our commitment to patients.

Behavioral health providers need to stop shirking responsibility and start leading. While we recognize that some work has been done, in our experience, providers who don’t measure outcomes or embrace value-based care may inadvertently contribute to the very problems they claim to solve.

The data tells a bleak story

We can see clearly in the data that our industry simply isn’t doing enough. According to data published by Blueprint, only one in five patients receiving psychotherapy experiences a clinically meaningful response. The fact that ineffective care is so widespread makes it unsurprising that patients drop out of care at alarming rates – only 36 percent of therapy patients stay in care until their fourth session of therapy. Too many patients are slipping through the cracks while most providers stick to outdated models, and we view it as our responsibility as provider organization leaders to change that.

It’s heartbreaking to think that so many people in need are taking the brave step of seeking help but aren’t seeing the improvements or getting the care they deserve. When providers prioritize volume over value, they fail not only patients but also the payers and systems that depend on them. To fix this, providers must tackle the root causes — the lack of measurement, inconsistent performance standards for clinicians, and patients staying in care too long or receiving unnecessary treatment so that mental health care truly helps people and leads to lasting improvement.

Accountability in behavioral health

Some leading health plans are pioneering the shift from volume-based to value-based care, showing that real change is possible. By focusing on accountability for outcomes, they’re helping to drive better patient results and lower long-term costs for health systems.

But it’s not enough. We need more payers to get on board with implementing meaningful changes that focus on outcomes. How can we structure this to set standards for outcomes industry-wide? To drive real change, we propose focusing on two key elements:

We need to set consistent standards for MBC

Studies show that fewer than 20% of behavioral health providers currently use MBC, but those who do see significantly better patient results. MBC makes it possible to track patient progress, offering real-time data to guide treatment adjustments, improving treatment quality and efficiency, and ensuring that it isn’t just about attending sessions but driving real improvement.

Some might argue that measuring outcomes adds unnecessary bureaucracy to an already overburdened system. But we’ve found that when done right – with the right technology and right training and support for clinicians – clinicians will embrace an MBC-oriented approach enthusiastically.

In the long run, we need industry-wide MBC standards, but we can start with individual health plans aligning on consistent requirements. We’re already seeing some progress here as the National Quality Forum (NQF) recently announced Aligned Innovation, an initiative intended to create a standardized and unified set of behavioral health outcome measures for use across stakeholder groups.

Consistent with the Aligned Innovation effort, we suggest that measurements will work best if they have the following features:

1. They should be brief, acceptable to patients, and repeatable.
2. They need to capture data relevant to different types of behavioral health conditions, such as distress, functional impairment, and quality of life.
3. They should collect information that is valuable to patients, clinicians, and payers.

Incentives must be aligned with outcomes

A recent report from Evernorth dives into the potential of value-based reimbursement in behavioral health to not only improve patient outcomes but also reduce costs. But making this shift isn’t that easy — it requires real collaboration between payers and providers to define what quality care looks like. This reinforces our belief that clear accountability standards, like those at the heart of measurement-based care, are a necessity for bridging the gaps in today’s system.

Value-based contracts can be a win-win-win for all stakeholders. By incentivizing high quality care, patients benefit from more effective treatment, payors benefit from higher quality care that reduces medical cost, and the most efficacious provider models will be financially rewarded. Financial incentives should encourage meaningful improvements in patient outcomes, with both upside and downside tied to performance. Tying more reimbursement to outcomes will also incentivize provider organizations to help patients get better faster instead of keeping them in long-term care that may not provide additional benefits.

Over time, we would expect value-based partnerships to continue to evolve, as innovative payers and provider organizations learn even more efficacious ways of collaborating to deliver on value.

A call to action for health plans

Even just five years ago, what we’re advocating for here might have seemed impossible. Today, some of the biggest health plans in the U.S. have begun to lead the way. We see more momentum than ever before toward aligning on standardized outcomes measures and expanding value-based contracting.

But there’s so much more work ahead. For too long, the behavioral health industry has lacked the accountability mechanisms required to deliver on the high quality care that patients deserve. Provider organizations are proving day in, day out that when strong accountability becomes the standard, patients benefit, and the system as a whole grows stronger.

The time to act is now. Together, we can create a system where outcomes truly matter and every patient leaves treatment better than when they started.

Photo: venimo, Getty Images

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