5 ways to help improve access to personalized behavioral health care

Making behavioral health care easier to access remains a critical challenge for payers, with real implications for outcomes and overall healthcare spending.

The goal is to help ensure members can easily find and access the care they need by building programs that:

• Support all acuity levels, from mild and moderate to high-severity conditions
• Prevent symptom escalation, improve outcomes and reduce total cost of care
• Offer flexible, tailored solutions to meet the diverse needs of members

Here are five initiatives leading payers are using to expand access while managing costs:  

Expanding access to behavioral health support plays an important role in improving outcomes while helping manage overall health care costs. When members can connect with care earlier — and in ways that fit their lives — they’re more likely to seek support before symptoms worsen.

It’s easier for individuals to access support in the ways that work best for them when they have multiple channels for receiving services such as:

• Digital resources
• Virtual visits
• In-person appointments
• Hybrid options

This multichannel approach can also help close care gaps in regions facing provider shortages, while increasing engagement and satisfaction across diverse member populations.

Data shows most people who use mental health benefits have low-severity symptoms spanning a wide range of mental health and substance use concerns.^{1, 2} In many cases, they benefit from evidence-based resources, tools and services that help prevent, reduce and manage stress and other mild symptoms while coping with everyday life.

When members have access to flexible support early on, they’re more likely to engage with self-care resources, address concerns sooner and stay on track with treatment or prevention plans. Over time, this can help prevent symptoms from escalating, reduce reliance on high-cost services and lower the long-term burden of chronic conditions — ultimately improving outcomes and lowering total cost of care.^{3, 4}

When members with serious mental health concerns are unable to access care, they often turn to emergency departments (EDs) for help. In fact, 1 in 8 ED visits involves mental health or substance use disorders symptoms.⁵

It’s critical to make it easier for these members to access appropriate support quickly and consistently rather than relying on EDs for less-acute needs. By offering programs with urgent mental health care access, payers can improve clinical outcomes and reduce out-of-pocket costs for members, while saving their organizations up to 500% in claims for ED visits.⁶

The “right” mix of benefits varies depending on your organization’s population but often includes:

• On-demand self-care resources, like the Calm Health app, for help managing mild stress, anxiety and depression.
• Digital and real-time assistance for in-the-moment support.
• Behavioral health coaching services for personalized guidance in managing mental health concerns and coping with life challenges.
• Urgent psychiatric care resources for serious mental health concerns that are not life-threatening but could worsen rapidly without intervention.
• Facility-based care and clinical case management for members with complex or high-severity needs.
• Specialty services and family support for SUDs, ADHD, autism spectrum disorder, eating disorders and other specialized care needs.  

Behavioral health care can be confusing. Too often, members don’t know whether they need care, what type of care they need or what’s available through their insurance benefits. By offering programs with personalized guided navigation, payers can make it easier for members to find the right support at the right time.

By leveraging data analytics, organizations can identify members who may benefit from support, anticipate potential risks and proactively guide individuals toward appropriate resources. This kind of targeted guidance helps members connect with care sooner and reduce unnecessary utilization.

Equally important is health literacy. Research shows 90% of U.S. adults lack the skills needed to fully manage their health, prevent disease and navigate the healthcare system.⁷

When people cannot understand health information, they’re less able to make informed decisions or take appropriate actions to care for themselves. Low health literacy is associated with increased hospitalization rates, longer hospital stays, higher readmission rates, greater use of EDs, medication errors and poor adherence to treatment plans.⁸

For these reasons, it’s critical for payers to deploy programs that equip individuals with clear resources and practical tools to better understand their health, assess their needs and make informed decisions about their care and treatment options. Examples include:

• Easy-to-understand educational materials
• Digital decision-support tools
• Care navigation services
• Personalized outreach

Ensuring members receive high-quality care is key to improving outcomes and managing costs. By giving them access to a broad, diverse network of behavioral health providers who are carefully selected, vetted and supported, payers help members achieve better outcomes.

High-quality care starts with clear frameworks and ways to measure success, track outcomes and keep costs under control. At the same time, it’s important to keep providers satisfied and motivated. This includes:

• Using value-based care programs
• Making it easier to acquire patients and schedule visits
• Maintaining a broad network — including specialty providers — to reduce the burden on individual clinicians and health systems

Care coordination also plays an important role, enabling members to benefit from holistic, integrated medical and behavioral health care. This includes cross-referrals, co-managing patients and conducting case reviews. Strong coordination helps:

• Make care more seamless
• Reduce duplication
• Improve the continuity of care
• Lead to better clinical outcomes

In addition, integrating Centers of Excellence within this coordinated framework gives members access to specialized expertise when it’s needed, in a cost-effective way.  

Reducing administrative burden is a key factor in making it easier for members and providers to receive and give care, respectively. Behind the scenes, payers focus on systems and processes that help members get the support they need — and make it simpler for providers to deliver it.

For members, this can mean:

• Finding in-network providers more easily
• Getting real-time price estimates
• Streamlined scheduling
• Simplifying pre-authorizations and other utilization management processes

For providers, it often involves:

• Reducing paperwork
• Improving communication and data sharing
• Simplifying prior authorizations
• Automating claims submissions
• Making it easier to coordinate care across teams

For example, a secure provider portal can give clinicians access to advanced analytic and administrative tools designed to make their work more efficient, effective and satisfying. They can also conduct secure transactions involving member or claims data, including:

• Checking a specific member’s coverage, benefits and eligibility for services
• Updating provider demographic information
• Submitting claims, checking claim status, reviewing payment information and submitting appeals
• Submitting and tracking prior-authorization requests

In addition, a secure portal can provide access to specialized patient wellness assessments that help identify behavioral health symptoms across different age groups. These assessments can include questionnaires used to screen for conditions such as substance use disorders, anxiety, postnatal depression, PTSD and early childhood autism. Providers can complete and submit these assessments through the portal for measurement and analysis.

Tools and processes like these help create a smoother, more seamless experience while improving member and provider satisfaction. They also free up valuable time and resources that can be redirected toward care delivery and patient engagement.  

The health care landscape is constantly changing — for example, new treatments emerge, member needs shift and payment models evolve. To improve outcomes while managing costs, payers need to stay ahead of these changes rather than reacting to them. Planning ahead helps programs continue to work well over time, giving members access to the care — and continuity of care — they need while helping payers manage risk.

Leading payers work with partners who provide deep market expertise, scale and flexible solutions. Modular capabilities allow programs to adapt as populations, member segments, standards and treatments evolve.

These capabilities make it possible to introduce new services or adjust program elements without reworking the entire strategy. As a result, payers can respond more quickly to shifting market demands, keep programs relevant and support long-term cost and outcome management.

By leveraging scale and adaptability, payers can maintain high-quality, cost-effective care while quickly addressing evolving needs, protecting outcomes and sustaining long-term value.  

Behavioral health isn’t one-size-fits-all. Members need access to the right support wherever they are in their journey and for whatever challenges they face. Programs that guide members to the right care and empower them to make informed decisions enable forward-thinking payers to drive meaningful improvements in outcomes and total cost of care.

By combining early access, specialized services, hybrid care delivery models, tailored guidance and health literacy support, members are more likely to receive care that aligns with their clinical needs and personal preferences. This integrated approach helps:

• Improve access and appropriate utilization of services
• Reduce care gaps and prevent symptom escalation
• Support better long-term outcomes and lower overall costs for payers  

At Optum, we work with health plans to support better outcomes and help manage cost of care by expanding access to providers, tools and resources that promote member engagement. Our analytics and care coordination processes help guide individuals to care that fits their needs, whether through in-person, virtual or digital options, with navigation support that helps streamline the experience.

We also collaborate with partners to design flexible, cost-effective operating models that adapt to population needs and proactively address gaps in care.