Behavioral health has entered a new era of accountability. Proof, measurements and improved outcomes are taking on renewed importance during a year that many anticipate will bring heightened scrutiny and uncertainty in the regulatory environment.
But a focused pivot from growth to proof does not mean that 2026 will be a year of slowed or stalled progress in behavioral health. Instead, industry insiders see it as a pivotal moment to justify growth through clinical value by tying scale and reimbursement directly to patient outcomes and lower costs of care.
“I want to start the conversation by immediately challenging the underlying assumption that growth and proving outcomes are somehow mutually exclusive or require a pivot, or that they have been happening in isolation,” Lindsay Arnold Sugden, CEO of SOL Mental Health, said during a recent Behavioral Health Business webinar. “I firmly believe that our first responsibility as healthcare leaders is to first deliver great outcomes to patients, and as we prove our ability to do so, then grow to create access to great care.”
SOL Mental Health provides outpatient mental health services in Colorado, New York, Virginia and Washington, D.C.
Uncertainty around Medicaid rates, requirements and eligibility also hangs in the balance, likely to create planning headaches and compliance hurdles during the year ahead. The Trump administration’s attempt to cut $2 billion in mental health and addiction care funding in January, followed by an immediate reversal of that action, added more volatility to the mix.
Major organizations like Crossroads Treatment Centers, one of the largest outpatient providers of substance use disorder and mental health care in the U.S., have made strategic decisions to prioritize low-risk investments at this time due to the federal unpredictability.
“Uncertainty doesn’t freeze operations at the end of the day,” Robert D’Annibale, vice president of growth of corporate development at Crossroads, said during BHB’s webinar. “We are here to serve our patients and provide exceptional care. What I would say is that it absolutely reshapes our risk tolerance. My team is making more conservative investment decisions, whether it be adding on additional resources, and then on top of it, a greater emphasis on compliance and audit readiness.”
Still, there is an opportunity for mental health, substance use disorder (SUD) and autism care providers to standardize quality and clarify practices, internally making things more predictable in the wake of industry shifts like this.
Honing in on reimbursement, lowering costs and prioritizing payer conversations will not only help organizations track and measure outcomes better, but it can also help them move deeper into stable value-based arrangements.
“There has been, over the past few years in all of health care, a desire to think about the whole person, the whole family, and think about all the care that a child and family would need to achieve their best outcomes,” Dr. Neil Hattangadi, CEO of Cortica Autism Care, said during BHB’s webinar. “There’s also a lot of emphasis around quality per dollar spent. And all payers — whether they’re health plans or employers or state governments — are starting to think ‘How can I be assured that every dollar I’m putting out there is driving the best outcomes?’ They’re thinking about those outcomes holistically.”
Cortica Autism Care provides autism therapy services across eight states, including Arizona, California, Connecticut, Illinois, Massachusetts, New Jersey, North Carolina and Texas.
Payer negotiations are notoriously challenging, and the current behavioral health environment is not making these easier. But steeper negotiations could be a sign of the field’s maturation. Organizations that can reliably deliver on key metrics and costs are generally in a better position to candidly shape the conversations around value-based models, rather than having contracts imposed on them, panelists shared.
“What are the metrics that you would like to be able to capture better? Having those sorts of candid conversations with your payer partners is important because it’s an evolving discussion to be had,” D’Annibale said. “There is a trajectory where the organization can work toward being able to report out on certain metrics, to be able to achieve some of those hurdles in the VBC world.”
It’s especially important for younger organizations to do this, D’Annibale added.
Value-based care can help stabilize organizations in volatile funding and regulatory environments because these arrangements typically offer more durable revenue streams than fee-for-service. This is why increased attention to outcomes, proof and measurements is also imperative. It aligns an organization with what payers and regulators demand and candid conversations can aid that alignment.
Although the road to reach that point can be long, particularly for newer organizations.
“Value-based care is a very long continuum, with mental health care largely on the far side of that spectrum and the fee-for-service arena and full-risk on the other side of that spectrum,” Arnold Sugden said. “We’re in conversations to try to step our way into performance-driven relationships with payers. We’re willing to go further into that spectrum as we develop the right kind of partnerships that reward the right kind of longitudinal opportunity as it relates to treating patients. In our experience, many payers are eager to have that conversation.”
Payers are also eager to partner to define the metrics, she said.
Since other parts of health care already operate on value-based arrangements, pivoting to value-based care is “a new world for behavioral health in general,”Arnold Sugden said. For years, the field placed priorities on access. Today, it has become “a different kind of conversation.”
Cortica Autism Care currently has 15 value-based contracts with its payers, Hattangadi said. Throughout those arrangements, the main components center around total cost of care, quality and access.
Because the company has added additional value-based contracts over the years, health plans and their members have incentives around the value points within those contracts that is separate from conventional CBT code billing.
“Now that we’ve done more, there are various flavors that we can bring to plans,” Hattangadi said. “Depending on their appetite for how complex they want to get, or how simple they want to make it, depending on the way a plan is set up, some carve out BH separate from medical, and we’ve been able to work through that too. But the spirit is always in solving for cost, quality and access in a whole person way.”