For years, behavioral health providers have lagged behind their physical health counterparts in measuring outcomes. While physical health providers can point to clear, quantitative indicators—such as lab results, imaging studies, or surgical success rates—behavioral health outcomes have traditionally relied on subjective self-reports and clinical impressions. This difference has made it challenging for behavioral health providers to demonstrate their value in measurable terms.
However, the industry is on the cusp of a shift. Increasingly, payers are pressuring behavioral health providers to show behavioral health outcomes before agreeing to higher reimbursement rates or value-based contracts. This evolution reflects a broader trend in healthcare toward accountability and evidence-based practices. Collecting meaningful behavioral health outcomes data, though, is not solely the responsibility of behavioral health organizations. Achieving a true outcomes-based approach requires robust data sharing between all parties involved in a patient’s care—including payers, behavioral health providers, and physical health providers.
Data Drives Reimbursement and Accountability
“A day doesn’t go by where I don’t get a phone call from one of our partners asking for higher rates,” said Trip Hofer, CEO of OptumHealth Behavioral Health Solutions, at the Behavioral Health Business VALUE conference. “If you want a higher rate … I need data. I need to see what you are doing.”
Hofer emphasized that not all data is equal. “I need to make sure it’s actionable. I need to make sure it’s consistent. Five years ago, you could have gotten a higher rate because you were loud. Now, it’s based on, ‘I need to be able to see behavioral health outcomes.’”
OptumHealth, the health services division of UnitedHealth Group based in Eden Prairie, Minnesota, manages care for over 127 million lives. For providers seeking higher reimbursement rates, demonstrating measurable behavioral health outcomes is no longer optional—it is essential. Without credible data, providers may struggle to justify their value, even when clinical results speak for themselves.
The Challenge of Standardizing Behavioral Health Outcomes
One of the most significant hurdles facing behavioral health providers is the lack of uniform outcome measures. Unlike physical health, where clinical metrics like blood pressure or hemoglobin A1C provide clear indicators of progress, behavioral health outcomes are often subjective and based on patient self-reporting.
“The challenge, of course, is that all of the measurements are so subjective,” said Deborah Fernandez-Turner, deputy chief psychiatric officer at CVS Health’s Aetna. “It’s based on a person expressing how they feel. We don’t have that clear, quantitative [measure]. We can’t look at a hemoglobin A1C and say, ’Oh, that depression is better.’”
Despite these challenges, many providers have invested aggressively in ways to measure behavioral health outcomes, both through complex, innovative methods and simpler, widely accepted instruments such as the PHQ-9 or GAD-7. These measures allow providers to track changes in depression and anxiety symptoms over time, providing a foundation for demonstrating effectiveness.
Collaboration and Breaking Down Silos
Even when behavioral health providers are actively collecting behavioral health outcomes data, the value of that information is limited if it remains siloed. For example, clinicians at Universal Health Services (UHS), one of the largest behavioral health operators in the U.S., track the percentage of patients who show statistically meaningful clinical improvement.
“It’s a necessary step. But it’s something that just hasn’t been done at scale,” said Mark Friedlander, chief medical officer of Behavioral Health at UHS. “There’s more to it than that. We know that medication adherence is a key component of a good outcome. We need the data from CVS; we need the data from the payers on what happens outside of our system.”
Behavioral health outcomes are closely tied to other aspects of a patient’s care, including physical health. Patients with complex conditions—such as serious mental illness coupled with substance use disorder and chronic pain—require coordinated care across multiple providers. When care is integrated and all parties share data, unnecessary emergency room visits and hospitalizations can be reduced, improving outcomes and lowering overall costs.
Friedlander illustrated this point with a patient scenario: “A patient with SUD and chronic pain is super expensive to the payers and requires care from behavioral health providers, pharmacists, and physical health providers. If all entities are coordinated, we could reduce ER visits. But we, on the behavioral health side, don’t get the data to quantify that. We need to be able to share the data so we can figure out who does what and who contributes what. It’s not all about the dollars and who deserves what share of the pie.”
Rethinking Outcomes and Time Horizons
Another factor that differentiates behavioral health from physical health is the timeline for outcomes. Behavioral health improvements can take months or even years to manifest, complicating the task of demonstrating a short-term return on investment (ROI).
“You can’t put a timeframe on the outcomes within mental health,” Fernandez-Turner explained. “It takes a long time to move into a recovery space for an individual. So how can we show a return on investment in one year? It’s just not possible. It really takes three years to really see benefits to the work that we’re doing.”
This reality highlights the need for payers to think differently about behavioral health outcomes. Short-term metrics may fail to capture meaningful improvements, and integrated, whole-person care models are often necessary to reveal the true impact of behavioral health interventions.
Barriers to Data Sharing
Despite the clear need for collaboration, several systemic barriers hinder effective data sharing. Behavioral health’s slower adoption of electronic health records (EHRs) compared to physical health creates challenges in exchanging information efficiently. In addition, privacy regulations around mental health data, while essential, add complexity to coordination efforts.
“I would love to get to a point where we’re just like, ‘Okay, listen, this is good for the head and the body,’” Hofer said. “But the reality is that that’s not what I face in a health plan environment. I have to go in front of actuaries who want to see an ROI. And I daily get in arguments with them, that this doesn’t make any sense. But that’s the reality right now.”
The Future of Behavioral Health Outcomes
As behavioral health providers continue to invest in measuring behavioral health outcomes and collaborating with payers and physical health partners, the industry is gradually catching up. Demonstrating measurable results is not just about securing higher rates—it has the potential to improve care quality, patient experience, and long-term recovery outcomes.
The future likely involves more standardized outcome measures, enhanced EHR adoption, and deeper collaboration between behavioral and physical health providers. Providers who can break down data silos and show clear, evidence-based behavioral health outcomes will be better positioned for value-based care arrangements and sustainable growth in an increasingly data-driven healthcare landscape.
While challenges remain, the shift toward measurable, actionable behavioral health outcomes marks an important step forward for the industry, payers, and, most importantly, the patients who stand to benefit from more effective, coordinated care.
