This is an exclusive BHB+ article
Payers face two main challenges in behavioral health: rising costs and ensuring their members’ access to care.
While partnerships with digital health providers and therapist enablement companies have helped combat access issues, some payers are taking a different route and bringing services in-house.
I can’t say it’s a surprising move. Behavioral health costs continue to rise, but unlike many other segments of health care, spending growth is primarily driven by sustained utilization rather than higher prices or greater care intensity, according to a new PwC report.
Both payers and patients are looking for ways to keep their costs down.
“Rising healthcare costs are forcing every stakeholder to examine costs, quality and value, and rethink their role in the system,” Thom Bales, Principal, US Health Services Advisory Leader, PwC, told Behavioral Health Business in an email. “Payers are looking for new ways to manage affordability, providers are under pressure to deliver value, and patients are increasingly bearing more of the financial burden. The organizations that succeed in the next decade will be the ones that move beyond traditional roles and work together to create a more transparent, consumer-focused, and sustainable healthcare experience.”
Given that utilization, not pricing, is driving spending growth, payers have fewer traditional cost-management levers at their disposal. Bringing behavioral health services in-house could give them greater control over care navigation, intervention timing and referral patterns. And members may be keen to try these services, as they are clearly in-network and offer lower wait times.
While some of the new tools aren’t necessarily a replacement for traditional services, just having immediate access could also help reduce the costs associated with urgent behavioral health needs and trips to the emergency room or urgent care.
Still, I wonder what the implications will mean for choice and the larger structures in place.
In this BHB+ Update, I will examine:
—The incentives for payers to launch their own mental health services for members
—How payers are looking to solve access issues with third parties
—The implications for digital health companies if payers do launch their own services
The landscape
Earlier this week, Aetna, CVS Health Corp’s (NYSE: CVS) payer arm, announced plans to roll out an on-demand mental health service to all members 13 and older on Jan. 1, 2027.
According to the company, during the initial test, on-demand clinicians were able to connect with members in as little as 13 seconds by phone, video or the member’s website. Meanwhile, the average wait time for a behavioral health appointment can range from 2 weeks to 3 months.
“Navigating the mental health system can be difficult. Individuals may not even know how to get started or how to find the right provider,” Miriam Ferriera, vice president of Aetna Mental Wellbeing, said in a press release. “We’ve simplified the experience for members to help them access care and take the next steps with our ongoing support and coordination.”
The platform is designed to support members through a single-session intervention model, including crisis management. Staff members can connect members to resources, schedule follow-up appointments, and support members’ ongoing mental health needs.
Behavioral health providers are notoriously difficult to find, and navigating a payer’s directory can be a Kafkaesque experience, often leaving patients frustrated. Therefore, a service like this offers a clear path forward and potentially a better understanding of cost.
Many payers’ health services divisions already offer virtual services. For example, Evernorth has MD Live. However, these services differ slightly, as they aren’t exclusively designed for members and aren’t necessarily pitched as first-line services.
While not every payer is developing a behavioral health platform specifically for members, the bulk of major health plans have invested in platforms to address the access challenge. For example, the venture arm of some of the largest payers, including UnitedHealth Group’s Optum, Cigna or Health Care Service Corporation (HCSC), has invested in therapist enablement platforms such as Alma or Headway. These platforms offer administrative support and in-network contracting services to independent providers.
Additionally, many health plans partner with these platforms to help their members access a network of providers. Some independent providers have even told Behavioral Health Business that payers have nudged them to use one of these platforms to get higher rates.
Aetna does work with therapist enablement platforms. However, recently, it announced rate cuts for Alma-contracted therapists.
Who loses out
The bigger question is who stands to lose if payers increasingly become the front door for behavioral health care. If more payers launch their own behavioral health services for members, it could become the first stop for members.
I doubt these services will have a major impact on brick-and-mortar providers, but they could make it more challenging for digital health companies competing for clients.
Interestingly, this comes as several large digital health companies have pivoted to an in-network focus. For example, Talkspace (Nasdaq: Talk) and Teladoc’s (NYSE: TDOC) behavioral health service, BetterHelp, have both moved from a direct-to-consumer to an in-network model over the last few years.
Talkspace has seen these efforts already pay off. In Q4 of 2025, its payer business made up 76% of the company’s revenue.
Overall, I think it was a smart move for these companies to go in-network. And I do think the demand is so large that it’s going to take a multipronged approach for care.
But if I were a digital health company, I would be watching one question closely: after these initial encounters, are payers referring members to external provider partners, or are they keeping those patients within their own care ecosystem?
If it is the latter, it is paramount that digital behavioral health companies understand what these providers are looking for in their partners when referring. Is it quality metrics, access, etc?
With utilization continuing to rise in behavioral health, I expect more payers to roll out their own mental health services for members. The bigger question is whether these offerings become a gateway to the broader behavioral health ecosystem or evolve into vertically integrated care models that reshape referral patterns and competition across the industry.