Outpatient mental health value-based care is rapidly becoming a priority for payers seeking to improve quality, enhance patient outcomes, and manage costs effectively. Large insurers and managed care organizations are at the forefront of developing and scaling value-based care models in behavioral health, particularly in outpatient settings where many patients receive treatment. However, the complexity of behavioral health services and the diversity of providers mean that true standardization has been elusive. Until the industry agrees on common performance measures and payment structures, many reimbursement arrangements will remain tailored to local markets or individual providers, allowing for some flexibility but also creating fragmentation.
Francis Terway, vice president of behavioral health business intelligence at Centene Corp., spoke at the Behavioral Health Business VALUE event about the company’s experience. Centene operates several outpatient mental health value-based care models, many of which are customized based on market dynamics or provider capabilities. Over the last two years, Centene developed a more standardized model intended for broad implementation across its Medicaid population spanning 30 states. This model integrates standardized behavioral health assessments, HEDIS patient satisfaction measures, incentives for maintaining community tenure, and risk-adjusted engagement metrics to account for the higher needs of complex patients. This effort reflects a move toward scalable models that can balance uniformity with responsiveness to diverse patient needs.
National Health Plans Driving Standardization in Outpatient Mental Health Value-Based Care
Centene is part of a larger movement among national health plans to prioritize value-based care in behavioral health. UnitedHealth Group, one of the largest insurers and health services companies in the U.S., is also heavily invested in this space. UnitedHealthcare, the insurance division of UnitedHealth Group, covered over 50 million members at the end of 2021. Its health services arm, Optum, recently acquired Refresh Mental Health, the country’s second-largest outpatient mental health services provider. This acquisition positions UnitedHealth Group uniquely, allowing it to influence outpatient mental health value-based care from both payer and provider perspectives.
This integration may accelerate the development and adoption of standardized models by aligning financial incentives with clinical outcomes more tightly across the care continuum. It also offers an opportunity to pilot innovative care delivery models that can be replicated at scale.
Providers Face Significant Challenges Adopting New Care Models
While payers have embraced outpatient mental health value-based care, many outpatient providers face substantial challenges. Katherine Tripple, vice president of value-based care at Foresight Mental Health, highlighted several barriers during the VALUE event. Providers are required to invest in new technology platforms, data analytics, and administrative workflows to collect and report quality metrics such as HEDIS, which are central to many value-based reimbursement models. This represents a significant shift from the traditional fee-for-service model, which has typically not demanded these capabilities.
For many outpatient providers, especially smaller organizations, building the necessary infrastructure and hiring staff to manage these processes is a daunting task. Tripple noted that few organizations have the bandwidth to develop these capabilities fully, contributing to a gap between payer enthusiasm and provider readiness. Despite this, Tripple remains optimistic that deals like Optum’s acquisition of Refresh Mental Health will spur momentum and resource sharing to help providers overcome these hurdles.
The Role of Technology and Service Organizations in Enabling Care Transformation
Companies such as Quartet Health are playing a pivotal role in bridging the payer-provider divide and enabling outpatient mental health value-based care. Susan Foosness, associate vice president of value-based care strategy at Quartet Health, described the company as the “technology and services engine” behind payer-provider partnerships. Quartet helps define appropriate outcome measures, streamline data collection, and design incentive structures that reward providers for delivering high-quality, coordinated care.
A key benefit of value-based care models is their ability to financially support non-clinical activities like care coordination, outreach, and patient engagement efforts. These activities often occur between billable clinical visits and are not reimbursed under fee-for-service. By incentivizing providers to invest in such supports, value-based care models can help improve treatment adherence, reduce dropout rates, and reach high-risk populations more effectively.
Terway emphasized that traditional fee-for-service models limit providers’ ability to invest in engagement activities for patients when they are not physically present in the office. Value-based reimbursement models expand this financial latitude, enabling a more proactive approach to patient care.
Designing Measures that Drive Engagement and Outcomes
Centene’s outpatient mental health value-based care model incorporates multiple measures to promote patient engagement and sustained treatment. Standardized behavioral health assessments and patient satisfaction metrics based on HEDIS serve as foundational tools to monitor quality. The model also includes incentives that reward providers for maintaining patients’ community tenure and ongoing engagement.
A critical element is risk adjustment, which recognizes that high-risk patients often require more outreach and support to remain engaged in treatment. Terway explained, “The highest-risk members are harder—it takes more work to establish that relationship and get them coming back into treatment.” The model compensates providers accordingly, encouraging persistence in outreach efforts and rewarding successful long-term engagement.
Strategic Provider Participation to Maximize Impact
Not all providers qualify for participation in Centene’s outpatient mental health value-based care model. Selection is strategic and based on providers’ capacity to engage high-risk populations effectively and deliver outcomes aligned with program goals. Susan Foosness noted, “We’re very strategic and selective in who is eligible and who participates. And we believe that’ll drive the best outcomes.”
This approach helps concentrate resources and incentives on providers best positioned to succeed under value-based arrangements, improving scalability and impact across the health system.
Looking Ahead: A Collaborative Path to Standardization and Better Care
The path forward for outpatient mental health value-based care will require continued collaboration across payers, providers, technology vendors, and policy makers. While significant operational and financial challenges remain, the growing momentum signals a meaningful shift toward more accountable, outcome-driven care models.
With careful attention to patient engagement, quality improvement, and sustainable reimbursement, outpatient mental health value-based care can better meet the complex needs of individuals seeking treatment while supporting providers in delivering high-value care.
Organizations interested in navigating this evolving landscape will benefit from tracking emerging best practices and partnering with technology and service organizations that facilitate data-driven, patient-centered care.
