Aligning Payment and Measurement: Do Current Incentives Support Quality Behavioral Healthcare?

Behavioral health integration is widely recognized as essential to whole-person care. Yet while the clinical case is clear, the business case remains fragile. Fee-for-service reimbursement models undervalue behavioral health services and fail to support team-based care, leaving many integrated primary care practices struggling to sustain models that have been proven to improve outcomes.

During a keynote session at NCQA’s Health Innovation Summit, Julie Seibert, MA, MPH, PhD, Assistant Vice President of NCQA’s Behavioral Health Center, moderated a discussion featuring Kari Clements, Senior Vice President of Quality at Elevance Health; Carin Skapars, LMHC, CPHQ, Chief Quality Officer at Carelon Health; and Debbie Witchey, President and CEO of the Association for Behavioral Health and Wellness. Together, they explored how payment models, quality measurement and healthcare infrastructure can better support integrated, whole-person care.

Key Takeaways From This Session

The Industry Has Moved Beyond Proving Integration Works

For years, healthcare leaders have focused on demonstrating the value of integrated behavioral health. Today, the challenge is no longer proving the concept. The challenge is creating a sustainable financial and operational model that allows integrated care to thrive.

Witchey noted that many existing payment systems were not designed around multidisciplinary care teams and often fail to reward prevention and early intervention, where much of the value of integrated care is realized.

This creates a significant challenge for health plans, clinicians and policymakers. While integrated care can improve outcomes and reduce downstream costs, reimbursement models frequently remain tied to individual services rather than coordinated care delivery. The panelists stressed that lasting transformation requires payment models that support team-based care and incentivize outcomes rather than volume.

Focus on Measuring What Matters

The panelists also challenged healthcare leaders to reconsider what defines success in behavioral health. While access remains a critical issue, particularly in communities facing practitioner shortages, the panelists argued that the industry must move beyond measuring whether patients receive care and focus more directly on whether that care improves their lives.

“We need to measure what matters,” Skapars said. “Is the care that’s being delivered actually improving the quality of life of the person receiving that care? Is it making their life better in terms of work, family? Are they able to do activities they enjoy?”

Prevention emerged as another priority. Current measures often focus on individuals after they have experienced a crisis or acute episode. “I don’t think we should be waiting until someone has one of these events before we’re measuring or doing something to engage them in behavioral healthcare,” Skapars said.

The panel also highlighted the importance of aligning measures across payer types, care settings and delivery models so organizations can create consistency and accountability regardless of where care occurs.

Interoperability Remains a Critical Barrier

If one issue united all three panelists, it was interoperability. Integrated care depends on timely access to information, yet many healthcare organizations continue to struggle with fragmented data systems and limited information sharing between behavioral health and physical health clinicians.

Skapars noted that behavioral health was largely excluded from the electronic medical record investments that transformed much of primary care following the HITECH Act, leaving many organizations at a disadvantage as the industry moves toward integrated care models.

Clements emphasized the need for greater collaboration with electronic medical record vendors and more standardization across systems to improve data exchange and reduce administrative complexity.

Witchey reinforced the central role data sharing plays in effective care coordination. “A warm handoff is important and critical,” she said. “But if you’re not physically co-located in the same place, then that needs to happen through the electronic health record. And that record has to have everything in it, be very clear and be easy to access.”

Building the Business Case for Integration

The panelists also made a compelling financial case for continued investment in integrated behavioral health.

Clements noted that many emergency department visits, hospital admissions and readmissions have underlying behavioral health drivers. Unmet mental health needs can affect an individual’s ability to manage chronic conditions, adhere to treatment plans and engage in preventive care.

“If you’re depressed or anxious, you’re not thinking about checking your blood pressure, you’re not thinking about eating well, you’re not thinking about exercising,” Clements said.

For health plans operating under value-based arrangements and organizations focused on Medicare Star Ratings and other quality programs, addressing behavioral health can directly influence both clinical and financial performance.

Witchey argued that the strongest long-term business case lies in total cost of care. Earlier identification of behavioral health needs, improved care coordination and stronger treatment adherence can help prevent more serious and costly health issues down the road.

A Vision for Whole-Person Care

Perhaps the most thought-provoking part of the discussion centered on whether healthcare should continue separating behavioral health and physical health at all.

Skapars challenged the audience to rethink the industry’s longstanding distinctions. “Have we artificially created this construct of behavioral health and physical health, when what we really mean is healthcare,” she said.

Clements described a future in which patients experience a seamless healthcare system regardless of where they enter. “I hope there’s no wrong door,” she said. “They walk into their care provider’s office and they are cared for from end to end.”

If those elements align, integrated behavioral health will no longer be viewed as an innovative model or a specialized initiative. It will simply become the standard for delivering high-quality, person-centered healthcare.

Learn More

We will post more insights from the Health Innovation Summit on our blog, so stay tuned.