For patients, navigating the U.S. behavioral health system is often a confusing and disjointed experience. They're not alone—many industry leaders feel similarly unequipped to make strategic decisions within the behavioral health sector because of the complexities of how patients and money move throughout the system.
Take, for example, a patient whose needs escalate while under the care of their PCP. After visiting the ED in crisis, the patient is admitted to an inpatient setting with the goal of transitioning to long-term specialty care. That means four (often) separate entities must work together to share data, communicate care plans, and ultimately smooth transitions in care. And those four entities may have entirely different financial models, some of which may operate outside of the health insurance system altogether.
Ultimately, this system-wide fragmentation is a driving reason for why there is no easy fix for the current behavioral health crisis. It's why many health plans carve out behavioral health services from their operations altogether. And this complexity also makes it challenging for new entrants and would-be innovators, like digital health vendors, to find staying power.
Use this resource library to better understand the roles of the primary stakeholders in the behavioral health care sector—including organizations that deliver and pay for care. Each installment includes an overview of the stakeholder's primary behavioral health services, target patient/member population, and financial model.