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The hardest part of navigating behavioral health challenges shouldn't be finding the right care.
Yet every day, people who need help face an exhausting cycle: multiple intake forms, repeated retellings of personal trauma, endless referrals, portal signups, long wait times, and a maze of insurance pre-authorizations and coverage limitations. Many simply stop trying to get care.
For many people dealing with behavioral health issues, lack of consistent treatment can lead to worsening symptoms—until they are in crisis and forced to seek disruptive and expensive emergency care.
When every step to getting help feels like climbing a mountain, even small barriers can seem insurmountable. Fragmented behavioral healthcare systems containing a multitude of small and large barriers are the norm in behavioral healthcare. But there’s a better way that prioritizes people instead of payers.
Continuum of care designs remove barriers, solve fragmentation problems, lower costs, and improve outcomes. To understand why this matters, let's examine how fragmented care affects those seeking care.
The cost of fragmented behavioral healthcare systems
Consider this real-world healthcare example. During my annual exam at the University of Washington, my doctor noticed a worrisome mole and recommended I see a dermatologist. What was the wait time for an appointment within the university system? Four months.
My only option was to look elsewhere. I found myself Googling dermatologists and making calls to check availability and insurance coverage. At my eventual appointment, I had to repeat the entire process: answering the same questions, filling out identical paperwork, and retelling my family history—the traditional fragmented healthcare system at work.
This fragmentation, frustrating in physical healthcare, poses an even bigger barrier in behavioral health, where continuity of care is essential. People experiencing depression, substance use disorders, or other behavioral health challenges often lack the energy to navigate this maze of providers, insurance, and lengthy wait times.
Fragmented care is costly
We’ve had members tell us in interviews that the exhaustion of having to retell their story each time they are onboarded with a new provider is a huge barrier to getting care and staying in it. Many people drop out of care because they don’t want to keep reliving their trauma with a new provider with whom they have yet to build a therapeutic alliance.
Fragmented care profoundly impacts the patient experience and costs payers, employers, and patients a significant amount of money.
Analysis of our customers’ claims data reveals that out-of-network claims for complex behavioral health conditions have more than doubled over the past four years, with out-of-network spending accounting for 32% of their total behavioral healthcare costs. This troubling trend tells us:
- People can't find in-network care, forcing them into expensive out-of-network
- Vulnerable populations, who often can't afford out-of-network care, get left behind entirely
- Treatment delays lead to more acute symptoms, resulting in more expensive and disruptive interventions (e.g., in-patient care vs. out-patient care)
The financial implications of the current system are huge. Onboarding someone into a new behavioral health program is typically the most expensive part of that program. When people are bounced between disconnected providers and services, these costs multiply.
Moreover, fragmented care makes it nearly impossible for stakeholders to measure return on investment or track treatment effectiveness within their behavioral health programs.
Critical transitions and care gaps
The traditional behavioral health system creates particular challenges during care transitions.
Consider someone leaving an in-patient SUD program who needs a lower level of care. Without immediate access to out-patient care that doesn’t require jumping through a bunch of hoops, their risk of relapse increases dramatically.
When I’ve spoken to practitioners who work with acute care scenarios, they’ve said that they often have to keep people in acute care longer than they think necessary because they simply cannot find out-patient treatment to discharge the person into. This costs significantly more money and more disruption.
Leveling up care
Let’s think about another example. When a therapist discovers their client needs specialized trauma care related to a childhood event causing PTSD, the patient is typically referred to an entirely separate system because they need higher acuity care—new insurance verifications, intake processes, and another round of retelling difficult personal experiences.
It’s possible that care won’t be available for months.
Further compounding these dynamics, about one-third of behavioral health providers don’t accept insurance, and ghost networks are common. Transitioning patients between levels of care—from higher acuity to lower acuity and vice versa—is filled with barriers and gaps.
Behavioral healthcare is typically structured so that providers work within independent systems with little overlap. Even when providers are highly effective individually, they are so isolated that there's no support structure to ensure comprehensive care coordination.
This isolation particularly impacts complex cases where multiple types of care are needed, as illustrated in the previous examples.
Spring Health’s approach to a continuum of care
When someone is experiencing behavioral health challenges, every barrier can feel like an insurmountable obstacle.
Spring Health’s mission is to eliminate every barrier to behavioral health globally. To do this, we have to pursue big opportunities. One of the biggest is creating a single platform through which we can offer a continuum of care for behavioral health treatment.
What does this look like?
- Collaborative care: We’ve created a centralized platform where different care providers—care navigators, therapists, medication managers, coaches, and peer advisors—can see each other’s notes and make one-click referrals in our electronic health records platform. Every provider can see scheduled appointments and view messages the member sends. Onboarding only happens once.
- Proactivity versus reactivity: the onus to find the right care shouldn’t be on the person struggling with their behavioral health or substance use. We do proactive outreach (a phone call or email, depending on the level of risk) to everyone who screens as being at risk. Outreach is done by a licensed, master’s level clinician who guides them through the entire process. The member is invited to enter into the Spring Health platform with one click to start their treatment journey.
- One point of contact: When a member needs acute care, a Care Navigator finds the right care, ensures the person has a place with a provider or facility, deals with pre-authorizations and insurance, stays on the line with the person until this process is complete, and finally, does a warm handoff. Once the person is in care, the Care Navigator keeps up with the person’s treatment and then ensures that the person can immediately transition to a lower or higher level of care when needed with no gaps.
- Meta-level data is foundational: Every single provider in our network utilizes measurement-based care. All of this data, in aggregate and de-identified, filters up to our Atlas platform and provides a range of analytics and insights for customers to be able to see population-level risk. For example, a health plan or employer might want to look at heat maps and see where people are struggling with SUDs and target them for proactive outreach. They can also view the total number of people at risk for behavioral health conditions in their organization or population. This data is also used to improve provider-patient matching and treatment plans.
As part of a continuum of care, a proactive approach enables organizations, via their behavioral health solution, to identify at-risk individuals early and intervene before conditions become acute.
Unlike traditional claims-based analysis, which only shows data after someone has sought care, an integrated system can initiate outreach within days of identifying potential issues.
Asking the right questions for behavioral health solutions
For stakeholders thinking about these issues, what are your next steps? When evaluating behavioral health solutions, I encourage consultants or organizational leaders to look past surface claims and ask the hard questions regarding:
- True provider network availability, wait times, and specializations
- Management processes and provider availability for complex care scenarios
- Procedures for upgrading and downgrading care levels
- Evidence of proactive versus reactive care models
- Integration of services and care coordination
- Data collection and outcome measurement capabilities
Many behavioral health solutions deploy a catch-and-release model of care.
They may tout care navigation, great partnerships, or a strong care ecosystem. However, frequently, this means the relationship between the case manager or care navigator and member boils down to a one-time interaction and is not representative of a true continuum of care.
A future with seamless behavioral health solutions
Seeking behavioral health treatment takes a tremendous amount of courage. Yet, too often, that courage is met with a maze of disconnected services, redundant paperwork, and exhausting retellings of personal struggles. This reality actively prevents people from getting the help they need.
An integrated continuum of care model offers a radically different type of experience. Instead of forcing patients to navigate complex systems while managing behavioral health challenges, they get seamless, coordinated support at every step of the process.
This approach delivers clear benefits for health plans and organizations: lower costs through proactivity and early interventions, better treatment outcomes through coordinated, measurement-based care, and comprehensive data to measure effectiveness.
We know what works, and we know how to do it. So, let’s create a future where every person has a genuine chance at recovery and a better life.
Give your employees the care they deserve with comprehensive behavioral health solutions that prioritize wellbeing and stay ACA-compliant.
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