A 2026 Vizient Impact of Change forecast found adult outpatient behavioral health volumes to rise 22% by 2036, more than seven times the 3% increase a population-based model would suggest.
For health systems, that gap between projected need and current capacity is already a daily reality. At Danville, Pa.-based Geisinger, the response has centered on a multiyear shift away from third-party telehealth staffing and toward building out an outpatient behavioral health workforce.
Imad Melhem, MD, chair of Geisinger’s Institute of Psychiatry & Behavioral Health, said the strain shows up in the system’s own numbers: On a typical week, it fields up to 900 requests for outpatient appointments but can only accommodate 600 to 650 of them, leaving a persistent gap of roughly 200 to 300 unmet requests.
Patients often face similar waits with other providers as they search for care, he said, which raises the risk that a person’s condition worsens before they’re seen. In some of Geisinger’s more rural service areas, he added, the system is the only behavioral health provider available at all.
Dr. Melhem said the system leaned heavily on outside telehealth partnerships after the pandemic hit.
“Multiple strategies that have helped systems like us meet the surge in demand during and right after COVID came at a cost,” Dr. Melhem said. “While helpful, our strategy focused on reducing the cost while replacing these partnerships, where and when possible, with an investment in our own workforce over the past few years.”
He declined to share specific dollar figures tied to the transition, saying only that the savings were significant.
The savings were not set aside so much as absorbed directly into service delivery, Dr. Melhem said. “Every cost reduction and investment in our own workforce was in and by itself an investment in more stable services, reduced variation in services,” he said. That work translated into a “significant [full-time equivalent] investment” in outpatient care, where the supply-and-demand gap remains a challenge, along with growth in consult services and inpatient capacity. Inpatient psychiatric capacity grew similarly, from 88 beds to more than 200, as the consult service shifted from largely locum-staffed to nearly fully employed
The numbers reflect that investment. Geisinger’s outpatient provider workforce has grown from just 26 providers in 2017 to more than 200 today, spanning psychiatrists, advanced practice providers, and master’s- and doctoral-level psychotherapists. Roughly 80% of the system’s outpatient behavioral health visits could now be delivered virtually, though Dr. Melhem said in-person care still remains a priority for patients. The system is also planning a new brick-and-mortar outpatient office within the next six months in one of its largest northeastern markets.
Dr. Melhem said staffing growth alone hasn’t closed the gap — Geisinger has also had to rethink how outpatient care is delivered. The system has built care teams that pair psychiatrists with advanced practice providers and case managers. A patient is then not limited to one provider’s open schedule and can instead be seen more quickly by a colleague on the same team while that provider continues to follow their case.
Managing the transition
Winding down reliance on outside telehealth staffing while ramping up an internal workforce carried its own risks, Dr. Melhem said. “We were very careful to preserve our partnership with our third-party partners and ramp down together, and kept some roles and partnerships until we were able to bridge the gaps,” he said. “Approaching this with transparency and working with our own teams and leaders to prepare and pace the transition was key.”
That included clear communication with internal departments that relied on those behavioral health services, such as emergency medicine and other hospital units, so they understood how and when staffing would change. In the early stages, Geisinger’s own leaders stepped in to help cover gaps left as outside contracts wound down.
Recruitment, Dr. Melhem said, did not always move at the same pace as the ramp-down of contracted services — particularly in harder-to-recruit specialties — which made contingency planning essential. “Pacing the pace of change with the pace of hiring, especially in hard-to-recruit areas, is key,” he said. “Recruitment doesn’t always go at the same speed of ramping down services, so having a contingency plan was important.”
Geisinger kept some services, including a partner for the intake component, where the company screens patients before sending them to the system. He said leaving “necessary” services, including child and adolescent or geriatric populations, until last allows leaders to study the areas of need and gain clear insight into the pace of recruitment.
Dr. Melhem said the third-party partners delivered strong care throughout the engagement.
Even so, he said, moving to an employed model brought benefits that were felt across the system, pointing to a less quantifiable gain — team stability that, over time, supports a culture of continuous improvement.
“The shift to having our own employed staff was felt in building more solid partnerships and reduced variations in the quality of service provided and led to more efficiencies in flow of patients and a better ability to coordinate care, especially on medically complex patient populations, and to build a culture that can improve over time given the stability of the team members.”
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