Capital Blue Cross took steps to broaden behavioral health access in recent years, contributing to a 9% reduction in related emergency department visits. Now, the insurer is looking to deploy similar strategies beyond behavioral health.
In an upcoming episode of the “Becker’s Payer Issues Podcast,” Capital Blue Cross Chief Medical Officer Jeremy Wigginton, MD, broke down the organization’s two-pronged approach to behavioral health.
The playbook
Capital Blue Cross built out its in-house behavioral health model, complete with integrated care management, as well as psychiatry and autism resources for complex cases. It also grew its behavioral health network by nearly 40% in 2025 and 2026, embracing both brick-and-mortar providers and virtual professionals.
“Access, navigation and clinical support work — they really need to fit together,” Dr. Wigginton said. “A larger network matters, and certainly provides more access, but members also really need clear ways to find care and support them in connecting to those care resources and the appropriate levels of care.”
The network expansion was driven by “good old boots-on-the-ground outreach,” observing utilization patterns for behavioral health professionals that were out of network or not in the area. During calls to those professionals, Dr. Wigginton’s team gauged interest in joining the behavioral health network and asked about barriers to entry.
“We got some varied responses,” he said. Some conversations centered on reimbursement, while others were about how partnership would work.
“We were pretty successful in being able to bring some of those additional providers within our network … by looking at those utilization patterns, by looking at geographic spread and doing that sort of targeted outreach,” he said.
Capital Blue Cross looked for strong virtual options, as well, considering both what other payers have done in the past and the needs of members and self-funded clients.
The approach also featured higher reimbursement rates, streamlined credentialing and lowered administrative burdens for smaller practices. Dr. Wigginton emphasized the importance of provider conversations when it comes to achieving these.
He said there are “some lessons to be learned that could be scalable around the approach,” but some details can be trickier to scale given variation across plans and markets.
“While we were able to build a model of approach that could certainly be scaled to other payers, every plan, every payer in every region is somewhat different,” he said. “It really depends on your capabilities, what your current fee schedule looks like, what your reimbursement rates are.”
The next frontier
While Dr. Wigginton acknowledged how behavioral health is “integrated” and embraced as part of a whole-person model, he argued behavioral health also requires “unique clinical expertise” — something that hints at which other healthcare areas could see similar approaches going forward.
Dr. Wigginton said there’s no shortage of opportunities to consider other healthcare areas that could benefit from such a model, but he is eyeing specialties with more complexity or long-term management. That includes autoimmune diseases.
“[With] many autoimmune diseases, there isn’t a cure-all,” Dr. Wigginton said. “Very similar to behavioral health, it comes down to: Are you adequately managing it? Are you managing the complications? Are you managing your comorbid conditions, and is your whole-person health being supported?”
Dr. Wigginton also mentioned gastrointestinal and perimenopausal care, particularly how the latter includes a behavioral health component and specific expertise on women’s needs.
“How can we expand our network? Are they the right expansion choices, and then how do we work with our care managers, our navigators, to outreach the right members to connect them to the most appropriate resources?” he said. “So far, building upon this model of behavioral health, I think we’re going to see some success in those areas, as well.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
