Closing Behavioral Care Gaps: Three Ways Providers And Health Plans Can Reimagine Care 

Millions of Americans are struggling to access physical and behavioral healthcare, and providers across the country are overworked, understaffed and face significant economic pressure. Nonetheless, they are expected to innovate and transform care. 

Care teams supporting patients with comorbidities and/or chronic conditions, including behavioral health conditions, face an uphill battle to navigate individuals in need to the appropriate care setting. Consequently, many individuals with these conditions end up in EDs, which aren’t designed or well-resourced for patients with complex challenges. 

We’re not approaching a healthcare crisis. We’re already in one. Every day of inaction costs patients their lives and wastes billions of dollars. 

Let the numbers speak for themselves: 

• 30% of healthcare spending is consumed by administrative costs or waste — billions of dollars going to paperwork and fragmentation instead of patient care.
• By 2028, we’ll be short more than 100,000 healthcare workers, stretching an already thin workforce even further.
• At the same time, health insurance premiums are expected to jump in 2026, creating affordability challenges for health plans, providers, and patients alike.
• And while 85% of healthcare leaders are exploring AI, real-time insights and streamlined workflow technology tools can serve as both a standalone innovation and a prerequisite for truly intelligent automation. 
• Layer onto this the behavioral health crisis:
  • 1 in 4 Americans lives with an underlying mental health condition.
  • They are 3.5 times more expensive to treat and 4 times more likely to end up in the ED.
  • Average wait time for BH services can exceed two months.

The results are predictable and devastating: Over-utilization of expensive care settings, avoidable ED visits, fragmented care and unsustainable costs that burden health systems and health plans across the continuum.

These challenges are most acute in the high-need, high-cost population, where 5% of patients drive roughly 50% of costs. Patients with behavioral health conditions account for disproportionate medical spending, largely because chronic stress worsens physical health conditions over time and leads to repeated exacerbations. This cycle results in poorer outcomes, but it can be disrupted through integrated, whole-person models of care.

A reimagined care delivery system is one that seamlessly connects and coordinates behavioral and physical care in real-time to support the whole person and bend the cost curve where it matters most. The question isn’t whether we can afford to coordinate care for high-need populations — it’s whether we can afford not to.

While collaborative care models are a step in the right direction, they have struggled to scale effectively. Real-time technology and innovation can help solve part of the collective problem, but ultimately, it comes down to the ‘last mile challenge’ – engaging these patients at the moment when they are most likely to engage with care teams and navigate them to the most appropriate level of care. 

Behavioral health support must become more connected than ever before if we want to affect real change. Reducing unnecessary utilization, expanding timely access to care and easing workforce burdens can help providers and health plans deliver improved healthcare for complex patient populations in the year ahead. 

Below are three key ways providers and health plans can meaningfully strengthen behavioral health support: 

1. Prioritize real-time data insights integrated directly into existing workflows to streamline care coordination and enhance outcomes for vulnerable populations with behavioral health needs. In today’s healthcare ecosystem, data is the fuel of our healthcare “machine”. Without it, we are highly suboptimized in our effectiveness. However, it’s not enough to simply have a lot of data in your system, which can further overwhelm staff. Care teams need relevant, easy-to-access insights in real-time so that they can act quickly during moments when it will really make a difference. When care teams have access to real-time data, they can intervene earlier for individuals at risk of relapse or escalation; they can coordinate follow-ups after behavioral health crises; and they can surface community-based clinical services before a situation worsens (rehabilitation and/or substance use disorder services/programs). Consider a patient who had major surgery and was prescribed opioids, only to later appear at the local ED a year later for an overdose. Typically, they might receive life-saving care and then be sent home, with direction to find treatment on their own, only to return to the ED again and again if they’re actively battling addiction. If the ED physician has access to the right real-time data, he can see that this individual was originally prescribed pain medication after surgery and is now caught in an uncontrolled cycle of escalations. In addition, if the physician has access to care navigation, this patient could be scheduled with the appropriate behavioral health provider/service for longitudinal care needs and could have a better chance for a positive outcome. 
2. Integrate physical health and behavioral health to create a 360-degree view of a patient’s health needs. By implementing connected care networks that can create an accurate whole-patient view, providers and health plans can work from the same information, together, to ensure patients receive the right care at the right time, reducing the likelihood of gaps in care. For example, a patient with Type 2 diabetes goes to his regular primary care physician. On paper, this patient has rising A1C levels and is not taking their medication as prescribed. The PCP may assume the patient needs stricter medication management or more education around his diabetic condition. However, if we integrate behavioral health into the equation, a new picture comes into view. When asked about any stress or challenges the patient is experiencing, the patient shares that he lost his job recently, which has made him feel depressed and anxious about providing for his family. These behavioral health challenges are directly impacting this patient’s ability to manage his diabetes. He’s not filling prescriptions because he’s trying to save money to pay other bills. From this example, we can clearly see that depression and anxiety are driving poor physical health outcomes, and they should not be treated as unrelated issues. 
3. Continue scaling value-based care efforts to drive costs down and improve outcomes. By incentivizing whole-person care, providers and health plans can continue shifting from reactive to proactive care by implementing data-driven models. Given that those with underlying behavioral health conditions are more complex to treat and are often routed to the wrong site of care, like EDs, these individuals incur additional costs. By funding proven models, like behavioral health care navigation and/or providing financial incentives for outcomes such as reduced hospitalizations, improved medication adherence, and sustained engagement in care, our healthcare system can shift away from crisis-driven responses and toward long-term stability.

Collectively, these three priorities — real-time data, integrated care, and value-based incentives — form the foundation for a more resilient behavioral health system in 2026 and beyond. When providers and health plans act as true partners, behavioral healthcare becomes more coordinated, more humane, and ultimately more sustainable for the system and the patients it serves.

Photo: Only Flags, Getty Images

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