This past Spring we asked leaders at health plans representing tens of millions of members to share their views on progress, priorities, and practices, when it comes to behavioral health. Over the summer we held dozens of one-to-one discussions with leaders from both payer and provider organizations. We hosted several roundtable discussions as well. In total we heard over three dozen perspectives, with leaders of organizations touching nearly 30 million lives. What follows are key themes and take-aways from this listening tour. 

Organizations are invested in change. Yet progress lags. 

Improving behavioral health is not only top of mind, it’s a top priority across healthcare. In fact, in a sampling of  triannual Community Health Needs Assessments completed over the past three years for 25 top health systems, behavioral health was listed as a top priority, in all reports, and in many cases the #1 priority. 

‍“Community leaders are begging for better behavioral health access. We need digital access too – kids don’t want to sit in a waiting room.”  – Hospital Executive, Ohio.

In fact, 67.6% of US counties have earned a mental health Professional Shortage Area designation, and 165 million of us live in these areas. 

‍“How do we reach people in rural areas?” – Medicaid Health Plan Executive, California.

The focus on behavioral health improvement shows up prominently among payers, too. Over 70% of those we surveyed ranked behavioral health improvement a top organizational priority – for one in seven it was the #1 priority for their organization. When asked what areas of improvement were most pressing, leaders focused first on the need to reduce wait times by expanding network access and telehealth. Ranking next in priority were improved telephonic support for care navigation, and stronger integration of physical and mental health. 

Integration is trending. Actual models may vary.

Nearly two-thirds of payer executives we surveyed say that integration of behavioral health is underway at their organization; nearly one-third say they are far along in creating an integrated care model. 

But “integration” models vary. Some describe an integrated experience, blending digital tools with care networks and live support. Others use integration to describe a “whole-person”  focus, recognizing the high rates of comorbidity between physical and mental health, and the role mental health plays in patient care plan adherence and engagement, and even in the healing process itself. 

For many, integration takes a tactical tone, tied to the preparation of primary care networks to address behavioral health as part of their overall focus on patient care.

‍“We’re providing training and tools to our primary care networks as a first step in integration.”  – Regional Health Plan Executive

At the same time, we heard skepticism from physician leaders across the country that it’s possible to adequately address patients’ behavioral health needs in a typical visit. Providers of care are often frustrated by administrative and payment barriers to better behavioral health. Provider network adequacy–in terms of capacity and quality of the network–along with time constraints remains major barriers to upstream and whole-person behavioral health care.

‍“We lack the time, the systems, and the severity triggers. With just a few minutes per patient it’s nearly impossible for physicians to squeeze this in.”  – Physician Leader, Regional Health System

Starting upstream and using a stepped care playbook makes sense. Not all the steps are in place yet.

Screening, early detection, and self-guided behavior change as first steps in a stepped care model has paid off when it comes to turning the tide on other chronic health conditions. Consider cardiovascular disease where  screening for early detection and self-guided behavior change have become standard for payers, providers, and consumers alike. The results are striking: a recent CDC analysis found that over 23 years starting in 1999, deaths due to heart attack declined 37%. 

But it’s not all good news: during that same period deaths due to suicide rose 35%. 

Though its early days for the stepped care playbook in behavioral health, our Roundtable experts agreed on the wisdom of starting upstream, expanding access digitally, and beginning with evidence-based self-guided care.  

‍“Population-wide proactive outreach—including digital tools—may help address issues earlier and more affordably.”  – Health System Executive 

They also countered the bias against digital for aging populations. 

‍“It’s a misconception that seniors won’t use technology.” – Medicaid Health Plan Executive

And they agreed that a stepped care model for behavioral health is needed. Though not all the building blocks are in place yet.

‍"A stepped-care model using severity indicators offers a promising way to guide individuals to the right level of support." – Executive, Integrated Delivery System

Bottom line 

Our leaders and experts also agreed on this:  it’s unlikely we can “treat” our way out of this problem. Beyond the high cost in doing so, there is a practical constraint: we can’t train professionals fast enough to meet burgeoning demand.

“The Health Resources and Services Administration (HRSA) estimates that by 2025, there will be a shortage of over 250,000 mental health professionals, including psychiatrists, mental health and substance abuse social workers, clinical and school psychologists, and school counselors.” – CEO and Medical Director, American Psychiatric Association, in a letter to Congress.

Beyond capacity, we need to think about processes, datasets, and access models. Patients and members need a better way to engage on their own, noting that surveys consistently find that three in four want to start there, with self-care. For the one in four truly needing clinical care, they need a better starting point, too.

‍“The reality is that people are often dropped into a fragmented system without a clear starting point.”
— Digital Health Solution Executive, Nashville 

Here are three steps to start. 

• Offer enhanced digital access. Build a better, more integrated “front door” to behavioral health. Smart triage begins early with proactive screening and rule-based routing to both evidence-based self-care and in-network care resources and programs.  Envision a mental health hub that serves as a “start here” easy button for patients and members needing support. It can not only help boost engagement, done well it activates better decision making.

• Bring a whole-person focus. Bring a more holistic focus to prevention, early intervention, and care. Mental health challenges are common to both chronic and acute health conditions. They drive ED visits, escalate costs, fuel unnecessary re-admissions, and hinder healing.  

• Close gaps in stepped care. With a simpler starting point, smarter screening, and personalized navigation to care, we move in the right direction for the roughly one in four members needing care now, while also providing digital tools to augment care management processes and improve quality. For the rest, AI-infused digital support helps tailor and scale this essential first step in the model.

“You can’t have meaningful engagement without personalization—and you can’t scale personalization without technology.”  – Behavioral Health Executive, Regional Health Plan

Finally, the good news: we have the knowledge and tools to advance the behavioral health stepped care model. Like all journeys, the one to better behavioral health starts with that important first step.

Clayton (Clay) Nicholas, MIS, MBA brings over 20 years of experience in healthcare innovations from startups to Fortune 50 firms. He previously led the Healthcare Provider division at Conduent, serving one-third of US hospitals with AI-driven care management solutions, and has held senior strategy roles at payer, pharmacy, and technology market leaders. He currently serves as Chief Commercial Officer at CredibleMind, a leading provider of digitally integrated behavioral health solutions reaching hundreds of communities, workforces, and health insurance plans nationwide.

‍Eric Zimmerman, MPH, MBA, has spent three decades at the intersection of population health, human behavior, interactive technology, and change. Coming from a family of mental health practitioners, he is passionate about system-level change in access, and about the integration of mental health into healthcare more broadly. He has developed solutions for health plans, hospitals, and workforces of all sizes. He currently serves as Chief Marketing and Market Solutions Officer at CredibleMind.