Access to behavioral health care in the United States remains one of the most pressing challenges in the health care system. More than a third of Americans live in areas without sufficient mental health providers. But experts say the real problem goes beyond provider shortages—it’s also about improving behavioral health access by changing how services are structured and delivered. Industry leaders believe these changes will pave the way for a new era in behavioral health care payment and delivery.
At the 2022 Wharton Health Care Business Conference, Katherine Hobbs Knutson—Senior Vice President at UnitedHealth Group and CEO of Optum Behavioral Care—addressed this issue in a health equity panel. She emphasized that inefficiencies in provider use are making it harder for people to get the right care. “You’ll have people with pretty mild conditions seeing a psychiatrist, who is the most highly trained and intensive resource,” she said. “Meanwhile, people with schizophrenia who need that level of care can’t access it.”
This misallocation is one of the many barriers to improving behavioral health access, especially for vulnerable populations. Too often, care is not aligned with patient needs, leading to poor outcomes, overuse of resources, and a lack of specialized care for those who need it most.
Breaking Down the Behavioral Health Silo
One of the structural challenges to improving behavioral health access is the traditional separation of behavioral and physical health services. Knutson explained how many insurance plans carve out behavioral health into separate companies, causing fragmentation. “That split contributes to a split care delivery system and leads to lack of coordination and poor access to care,” she said.
Optum is taking steps to bridge this divide. By integrating behavioral and physical health care, the organization is fostering a system that treats the whole person. Integration also helps lay the groundwork for value-based care, where outcomes—not volume—drive payment and performance.
Value-based care is increasingly seen as a powerful tool for improving behavioral health access. When providers are incentivized to keep patients healthy and out of crisis, the entire system becomes more proactive and patient-centered. Knutson believes the shift toward integration supports not only better outcomes but also greater efficiency and equity.
Value-Based Care as a Gateway to Access
In value-based models, health outcomes drive financial incentives. For behavioral health, this means rethinking how care is delivered and compensated. Knutson posed a powerful question during the panel: “How can we get clinically and cost-effective services to vulnerable populations and address all those barriers to them actually accessing care?”
The answer lies in redesigning care delivery models. One promising approach is “reverse integration,” where primary care providers are embedded within behavioral health care teams. This ensures that people with mild to moderate behavioral health needs still have access to general medical care without leaving the mental health environment. It’s a model that recognizes the importance of addressing both mental and physical health in tandem—a crucial step toward improving behavioral health access across the spectrum.
Reverse integration also reflects a shift toward more holistic, coordinated care. Instead of treating symptoms in isolation, providers take into account a patient’s full health and social context. This approach is especially valuable in treating complex conditions that involve both physical and behavioral dimensions.
Technology: A Critical Tool for Expanding Access
Technology has played a vital role in improving behavioral health access, especially in the wake of the COVID-19 pandemic. Optum has reported a 130% increase in telehealth utilization since 2020, with even higher rates among Medicaid participants. For people in rural areas, those without reliable transportation, or individuals who face stigma in seeking in-person mental health support, telehealth has opened new doors.
Virtual behavioral health care is not only more convenient but also allows providers to operate more efficiently. However, to maintain this progress, telehealth must be seamlessly integrated into existing care systems. This means supporting secure data sharing, facilitating warm hand-offs between providers, and enabling escalation to in-person care when necessary.
By embracing virtual tools within a value-based framework, providers can reach more people and provide consistent, high-quality care—another key factor in improving behavioral health access at scale.
Data and Equity: Building Accountability into Access
Even the best-designed care models can fall short without accountability. That’s where data comes in. Nora Dennis, lead medical director of behavioral health and health equity at Blue Cross Blue Shield of North Carolina, emphasized the importance of using data to drive equity. “We all have a theoretical commitment to equity,” Dennis said. “But we actually need to make that material, and we need there to be accountability using data to stratify the population.”
Blue Cross NC is working on provider contracts that include guarantees or bonuses tied to performance metrics around equity. These value-based incentives reward providers who not only improve outcomes but also reduce disparities. That’s a crucial element of improving behavioral health access—ensuring that progress benefits all populations, not just those already well-served by the system.
Dennis warned that without this level of accountability, efforts to improve quality could inadvertently widen disparities. “We don’t want improvements in quality in one subset of the population if that is actually going to widen the existing disparity,” she said. “You have to address the health of the entire population in order to truly be driving value.”
A New Path Forward for Behavioral Health
The future of behavioral health care depends on tackling access issues from every angle: redesigning provider roles, integrating benefits, expanding telehealth, leveraging data, and building systems of accountability. Each of these steps contributes to improving behavioral health access in meaningful, measurable ways.
Industry leaders agree that more providers alone won’t solve the crisis. Real transformation comes from optimizing existing resources and aligning incentives to support better outcomes. Through integrated care models and value-based strategies, organizations like Optum and Blue Cross NC are showing what’s possible.
As stakeholders across the health care landscape embrace this change, improving behavioral health access is no longer just a goal—it’s a shared responsibility. With the right structures in place, the system can move from reactive to proactive, fragmented to coordinated, and inequitable to inclusive.
Ultimately, improving behavioral health access is about more than reaching more people—it’s about delivering the right care, at the right time, in the right way. That’s the future behavioral health care needs, and the one it deserves.
