Does Your Population Need a Large Behavioral Health Network?

Overview of large behavioral health networks

Typically, behavioral health networks are composed of independent contractors. Network vendors’ recent strategy for expanding access is to stitch together multiple subcontractors. The intent is to bridge gaps in a current network, such as in specialty areas, like pediatrics and substance use disorders (SUDs).

What began as an effort to increase the availability of in-network mental health professionals has morphed into a confusing hodgepodge of therapists, apps and subcontractors that vendors described as comprehensive networks.

There are several ways plan sponsors can contract with large behavioral health networks. Major insurance companies offer them. There are also companies that specialize in offering large networks — often referred to as standalone vendors — that operate independently of insurance companies. In certain cases, some plan sponsors create their own custom behavioral health networks. This approach typically works best for plans seeking to fill an identified gap in their networks, such as pediatrics.

Vendors of custom behavioral health networks usually provide carve-out services offered in tandem with separately administered medical and surgical benefits. Specialty mental health/SUD administrators may offer the network, provide utilization management services or do both.

Why consider a large behavioral health network?

They present several distinct advantages:

• Size is the primary advantage. More providers mean more choice for participants. Major insurance companies offer large behavioral health networks that have hundreds of thousands of providers. Standalone, large behavioral health networks have tens of thousands of providers.
• Large behavioral health networks have geographic reach. Typically, they have providers in most, if not every, state.
• Participants get faster access to care. More in-network providers increase the likelihood of getting a quick appointment.
• Large behavioral health networks offer a broad scope of services. They were among the first to offer and continue to promote telebehavioral healthcare.
• The best networks collect and monitor objective measures of evidence-based care and clinical improvement. However, this advantage isn’t characteristic of all behavioral health networks.
• The best networks have a case-management team to monitor acute cases and coordinate follow-up and step-down care. But not all behavioral health networks have case-management teams.

The benefits of a custom network include enhanced access, high-quality specialty care and care navigation provided by experienced MH/SUD experts.

What to look out for when considering a large behavioral health network

There are several disadvantages to consider:

• A large number of providers does not ensure a better experience in accessing care. Given the predominance of “ghost networks,” a network with 100,000 therapists does not necessarily offer better access to providers than a network with 10,000 therapists. Ghost networks occur when providers are listed as being in a network, yet they are not available to patients because provider directories may be outdated, the provider has become unreachable or the provider is not accepting new patients. Some providers may be under contract with a network but limit the number of hours a week for the network’s patients.

  The Employee Benefits Security Administration conducted “secret shopper” calls to several thousand outpatient mental health providers listed as available to accept new patients. Dishearteningly, many were unreachable or did not return the calls, and less than 30 percent had an appointment available within a month. This means a participant might have to contact multiple prospective mental health providers before finding one with an acceptable wait time.

• The same providers may be available on multiple platforms. Depending on plan design, such as employee assistance programs or first-dollar coverage of telehealth, the same provider may be available to a participant through more than one platform with different cost sharing. This redundancy and cost difference can lead to participant confusion and surprise bills.
• Paradoxically, the choice advantage can also be a disadvantage. Participants may feel overwhelmed about how to select a provider from so many options. This can lead to disengagement from care, delayed treatment and higher utilization of acute services.
• The number of resources available to participants can be overwhelming. Participants might be required to download multiple apps, visit more than one website and/or sort through confusing, disjointed lists of services. A participant who receives a list of numerous platforms to sift through when searching for a provider will struggle to find the time and effort to do so. Sometimes, appointment availability is not visible on the platform, and the participant has to contact the vendor and wait for a reply.
• Therapeutic alliance may be difficult to achieve. Therapeutic alliance (e.g., age, gender, language, ethnicity, cultural heritage, veteran status and treatment style) is a key component observed in clinical improvement. Yet when each platform has different criteria to filter (or has no way to filter results), then the provider that fits best with the patient may not be in the top results.
• In-person care, which participants tend to prefer, may not be available. A disproportionate percentage of mental health providers have shifted to providing only telehealth care. The shift to virtual-only care disadvantages participants who do not have reliable access to technology or who feel uncomfortable using it. It may also not be available to treat all conditions, as illustrated below using data from Segal’s SHAPE health data warehouse, which includes information from health plans across the United States, representing a range of industries and organizations that collectively cover more than 4 million lives.
• Clinical quality may suffer. Because vendors of large behavioral health networks don’t own the partnerships with which they contract, they have limited control over the quality of services. When multiple smaller networks or apps are stitched together — most of which do not report on evidence-based care — then the vendor has no way to rank providers and curate networks for quality. Consequently, plan participants may experience poor-quality care that does not alleviate symptoms and discourages them from continuing care.
• Coordination and follow-up support may be lacking. When nested applications or networks provide care without involvement from the overarching vendor, case management is not alerted to crucial transition points in recovery that require time-sensitive intervention. There is also confusion about what, if any, support the nested applications are providing. This lack of transparency leads to missed interventions.
• Opaque decision-making for plan sponsors. If disparate platforms collect and share utilization or outcomes data, the vendors tend to provide each of these results as separate reports for plan sponsors. This makes it difficult for plan sponsors to visualize overall reporting and to understand overall trends that are impacting plan participants. This leads to missed opportunities in tailoring programming to meet emerging needs.

The challenges of a custom network include cost and coordination of overall services and communications, as well as compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA).

Almost 30 Percent of In-Person Visits for Mental Healthcare in 2025 Were for Anxiety*

  * Totals does not equal 100 percent due to rounding.
** “All others” includes obsessive-compulsive disorder, schizophrenia, eating disorders and neurodevelopmental disorders.

Source: Segal’s SHAPE health data warehouse

How to make a large behavioral health network work for your organization

Plan sponsors should follow four steps to ensure the introduction or ongoing support of a large behavioral health network is successful.

1. Ensure network adequacy

To determine network adequacy, an accurate metric is the number of providers that have a verified appointment available within 10 days. If the network vendor being considered does not report wait times until the next available appointment, consider requesting that metric.

A small network that can prove timely availability is more useful to a participant than a bloated network that either cannot measure or cannot confirm availability. This is true as long as in-person care is available in locations in which plan participants live.

Knowing what your population demographics are and what behavioral health benefits your people need is an important foundation for this step. I describe six best practices for designing effective behavioral health benefits in my recent article, “Tailoring Behavioral Health Services for Your Population.”

2. Insist on care navigation

Care navigation connects the participant — and, in some cases, the family — to the appropriate services based on their clinical needs. Ideally, this is facilitated by nurses or social workers who specialize in mental health and SUDs. For a patient who is overwhelmed by their treatment needs, it removes the burden of navigating the healthcare system on their own.

Care navigation may be provided either through the network vendor, a behavioral health point solution or a general clinical care navigation vendor. While care navigation is beneficial for all types of conditions, it is especially valuable for mental health, given the complexity of the networks compounding the challenge of understanding appropriate levels of care for a person’s unique needs. Care navigators can bridge the gap between platforms and create a cohesive plan of care out of disjointed networks.

Considering the two-year trends by place of service shown in the next graph, it is preferable to see higher utilization of less-acute levels of care, such as telehealth and outpatient claims costs, compared to inpatient and residential treatment, which indicates participants are receiving care before their conditions deteriorate. However, emergency room (ER) costs for mental health conditions have increased at an uncomfortable pace. This is why care navigation is so vital: care navigators can prevent inappropriate ER utilization by participants who cannot arrange more appropriate levels of care without assistance.

Two-Year Mental Health Cost Trends by Type of Service, 2023–2025

Source: Segal’s SHAPE health data warehouse

3. Watch the data

Ask the network carrier to describe what data it will routinely provide on utilization and clinical outcomes. Even if data is not collected from all platforms within the network, persist in getting the separate reports, when available, and reviewing them for next steps.

These reports may reveal surprising participant utilization patterns, such as utilization of various platforms by age group, that may suggest how to improve the benefit. For instance, if a high percentage of participants are seeking care for stress, it may be helpful to offer them access to credibly written articles, podcasts and meditations.

4. Pay attention to the details

Mental health benefits will still be lacking without careful deployment that appeals to participants’ interests while dispelling stigma that may prevent use. The true measure of a mental health program is whether it actually helps members feel supported, understood and able to access care when they need it.

As a consultant, I witnessed two clients roll out the exact same vendor program. The first client provided perfunctory support for the program once it was available to participants; all the communications materials from the vendor were used as recommended. The second client intentionally deployed the benefit to appeal to the unique audience, including promoting it with various types of communications (including high-traffic areas visible to participants), mentioning it during meetings and showing that leadership and other influential people support and use the program. The first client’s program garnered about one-third to one-half of the utilization of the second client’s program. Multichannel communications plus visible buy-in from leaders and managers helped drive awareness and normalize use of the behavioral health benefits.

To learn more about how to drive meaningful use of behavioral health benefits, check out my article, “Tailoring Behavioral Health Services for Your Population.”

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