As behavioral health needs rise nationwide, health systems and provider organizations share how they are collaborating with payers to strengthen continuity of care and manage costs.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you partnering with payers or health systems to expand access and improve continuity of care?
Corey Cronrath DO. Chief Medical Officer at Mental Health Cooperative (Nashville, Tenn.): At Mental Health Cooperative, our conversations with payers are centered on moving away from fee-for-service toward shared savings and per-member-per-month models that include outcome-based incentives. Fee-for-service incentivizes volume such as more labs, more medications and more referrals. In contrast, value-based care rewards us for improving outcomes and lowering the total cost of care. That shift allows providers the time and flexibility needed to deliver high-quality, person-centered care.
One way we operationalize this is by examining high-cost populations such as individuals with schizophrenia. We studied outcomes for patients on long-acting injectables versus oral antipsychotics. Our initial hypothesis was that LAIs would drive superior adherence and downstream outcomes, but the data told a more nuanced story. While adherence rates were not significantly different, LAI patients experienced fewer inpatient admissions, and those on oral medications achieved better compliance with diabetic retinal exams. We believe this surprising finding reflects our integrated model that centers mental health care around social workers addressing social determinants of health, helping patients overcome barriers to preventive care.
This type of analysis underscores how value-based partnerships with payers enable us to align incentives, focus on quality and better manage severe mental illness. When we reduce avoidable ED and inpatient utilization, we free up acute care capacity for true medical emergencies, improving access for the broader community. And by managing chronic psychiatric illness more effectively, we also reduce the number of provider visits needed per patient each year, which opens access for others who need care.
Omar Fattal, MD. Deputy Chief Medical Officer and System Chief for Behavioral Health at NYC Health + Hospitals (New York City): We are the largest public health care system in the U.S. and the leading provider of behavioral health services in New York City, serving nearly 80,000 people each year across 11 hospitals. To expand access and strengthen continuity of care, we developed a three-year strategic plan and restructured our Office of Behavioral Health around systemwide priorities rather than siloed services.
This shift enabled us to function as one unified system — centralizing workforce initiatives, creating a transfer center to move psychiatric patients seamlessly across facilities and building a contact center to schedule outpatient visits across hospitals. These changes positioned us to better partner with payers and align with other health systems around shared goals: expanding capacity, improving patient flow and ensuring care is delivered at the right level without unnecessary delays.
The results are tangible: nearly 1,100 inpatient psychiatric beds closed during the pandemic have been fully reopened, census has returned to pre-COVID levels and outpatient visits have grown by double digits. Most importantly, since March, our transfer center has supported nearly 250 children by moving them from crowded emergency departments into inpatient psychiatric beds within our system — providing timely, continuous care that might otherwise have been delayed for days or weeks.
Stephen Merz. Vice President and COO at Sheppard Pratt Solutions (Towson, Md.): Partnerships begin with population-based need assessments and care continuum gap analysis and grow into service deployment and defined planning with payers.
Michael Midgette. Chief Growth Officer at Thriveworks (Lynchburg, Va.): Our partnerships are built around a shared goal: expanding timely access and ensuring continuity of care through clinical collaboration and empowered providers.
Regarding access, Thriveworks has a hybrid care model that offers either in-person and virtual appointments, with accelerated speed to care. Many of our clients are able to see a provider that same day, and because we are in-network with nearly all major health plans, financial barriers are reduced.
On continuity, we’ve invested heavily in infrastructure that allows us to scale quickly in shortage areas, while also coordinating with fellow behavioral health providers offering higher levels of care, substance use treatment and health systems. That means a member who comes to us won’t be left navigating the system alone. They can move seamlessly between different levels of care with Thriveworks staying connected throughout.
