The Payers Hold the Power—and Startups Are Paying Attention
In the complex and highly regulated world of health care, payers wield outsized influence. Unlike traditional commercial markets where consumers drive demand and shape innovation, health care is largely shaped by who controls the money. And in the U.S. health care system, it’s the payers who hold the checkbook—especially when it comes to behavioral health. That’s why Payer Mental Health Partnerships have become a strategic lever for startups and providers looking to innovate at scale and reach underserved populations.
That dynamic becomes especially important in mental health, where startups are racing to solve everything from workforce shortages to engagement gaps through digital tools and novel delivery models. Despite their energy and innovation, however, these startups face a hard truth: without payer partnerships, even the most promising solutions struggle to scale.
There are hundreds of behavioral health startups now competing for attention, but far fewer large payers. This imbalance means that mental health innovators must not only demonstrate the effectiveness of their solutions—they must also align strategically with payer priorities. That’s why many of the most ambitious startups in the space have turned their eyes toward Payer Mental Health Partnerships with companies like Aetna, one of the largest health plans in the country.
Aetna’s Expanding Mental Health Mission
Aetna, which serves around 39 million members and is owned by CVS Health (NYSE: CVS), has become one of the most sought-after partners in the behavioral health space. Under the leadership of Cara McNulty, president of behavioral health and the Employee Assistance Program (EAP), the organization is pushing hard to expand access to high-quality mental health care through a combination of technology innovation, community partnerships, and systems transformation.
But while Aetna is open to partnering with outside startups and digital health providers, it’s not interested in volume for volume’s sake. Instead, the company is highly selective and operates with a clear strategic lens.
“When you think about how a partnership with us works, first of all, our goal is to democratize access,” McNulty said during the Going Digital Behavioral Health Tech event. “And not just access – quality access to care for anyone we are serving, wherever they are at in their journey.”
That last part—”quality access”—is critical. In a marketplace flooded with mental health apps, AI-driven tools, and fragmented platforms, Aetna is focused on finding Payer Mental Health Partnerships that deliver measurable outcomes across the full spectrum of behavioral health needs.
A Full Continuum Approach: From Stress to Serious Mental Illness
Aetna’s mental health roadmap doesn’t start and stop with mild anxiety or virtual therapy appointments. Instead, its strategic objectives cover a broad range of acuity—from low-intensity mental wellness services to serious mental illness treatment for conditions such as bipolar disorder and schizophrenia.
Meeting that kind of need requires more than patchwork innovation. It requires a long-term, comprehensive strategy—and a network of trusted, effective partners who can help execute on that strategy.
“We have a robust strategy,” McNulty explained. “That strategy is about guiding, connecting and reinventing.”
Each of those three elements plays a role in how Aetna thinks about care transformation and how it evaluates Payer Mental Health Partnerships.
Startups Must Fit the Model—Not Just Be Innovative
For digital health startups, the temptation is often to lead with technology. But Aetna is signaling that innovation alone is not enough. What matters is whether the startup’s solution fits within Aetna’s strategic pillars and can deliver against the company’s larger vision for transforming behavioral health.
Importantly, Aetna sees partnerships as two-way streets. Some startups are selected and invited into conversation; others reach out on their own. Either path requires a deep understanding of what Aetna values.
“Partnering with us is a two-way connection,” McNulty said. “We may be reaching out to a partner or solution because we have heard about something that they have that would help us along this guiding, connecting and reinventing [journey]. Or they are reaching out to us and they are making us aware of what they have.”
To facilitate these partnerships, Aetna hosts quarterly summits that function as a type of internal pitch day. These curated events give selected startups a chance to present their solutions, meet Aetna decision-makers, and better understand the questions the payer is asking internally.
These summits have become a gateway for Payer Mental Health Partnerships, giving startups insight into the kinds of solutions Aetna values and how they assess vendor fit.
“We run a pretty tight process,” McNulty said. “There is just an influx of tech and digital providers, specifically in this mental health space. So we need a way to curate, to understand where people are at, and [where] these solutions are at and if they are a good fit for us.”
Startups that want to build strong Payer Mental Health Partnerships with Aetna need to bring more than a product—they need to bring a partnership mindset, clear clinical outcomes, and a plan for integration into a complex ecosystem.
Reinventing Mental Health, Not Rebuilding the Old System
Perhaps most notably, Aetna is not trying to repair the current mental health system. It’s trying to reinvent it.
“When we say reinventing, we’re not interested in fixing a broken mental health system that was built in the 1800s,” McNulty said. “We are reinventing how we innovate, partner and drive care and outcomes.”
This forward-looking perspective means that Aetna is less interested in Band-Aid solutions and more interested in those that fundamentally change the way care is delivered, accessed, and measured.
That’s where technology becomes central to Aetna’s strategy. Whether the solution is developed in-house or sourced through an external partner, the focus is on tools that can meet members’ needs earlier, faster, and more intelligently.
This is where digital health innovators can truly shine—if their tools and workflows are built to support scalable, measurable, and system-wide transformation in Payer Mental Health Partnerships.
Suicide Prevention and Measurable Outcomes
One of Aetna’s most ambitious mental health initiatives is to reduce suicide attempts by 25% by 2025. It’s a bold goal—and the kind of outcome-driven initiative that resonates with both members and potential partners.
The organization has already made significant progress, achieving a 22% reduction in suicide attempts within its adult population. That success is due in part to data analysis, proactive outreach, and risk identification tools, all of which fall under the umbrella of the company’s evolving Payer Mental Health Partnerships strategy.
“We flew past our goals,” McNulty said. “I am so, so proud—and we couldn’t have done that without policy and systems, and technology, and some risks.”
But Aetna’s work isn’t finished. The company is now focusing on the pediatric population—especially children under 13—where suicide attempt rates remain high and early intervention is more challenging.
“You see us deploying and researching innovation and resources around partnership and resources we can make in that child population,” McNulty said.
Startups with proven track records or research in youth suicide prevention may find this to be an especially timely opportunity for future Payer Mental Health Partnerships.
Final Thoughts: Innovation Meets Alignment
As Aetna continues to lead the way in behavioral health strategy, the takeaway for digital health startups is clear: the future of mental health care depends on alignment, outcomes, and integration. It’s not just about building cool tech. It’s about forming Payer Mental Health Partnerships that are grounded in mutual goals, measurable impact, and operational fit.
In this new landscape, the most valuable partners will be those that understand not just what care looks like—but how payers think, operate, and prioritize transformation.
