A Payer Solution to Improve Access to Quality Behavioral Health Care

Area of Science:

• Healthcare Management
• Public Health
• Digital Health

Background:

• The United States faces a significant behavioral health (BH) crisis, marked by increasing condition incidence across all age groups.
• Inadequate BH provider supply, staffing shortages, provider burnout, and inefficient case assignment models limit access to timely care, with wait times up to six months.
• The COVID-19 pandemic has further exacerbated existing challenges in the BH landscape.

Purpose of the Study:

• To improve the quality and clinical outcomes of BH care for Highmark members.
• To expand access to BH interventions and create a data-informed system for operations and clinical decisions.
• To track key outcome measures, assess program impact, and reduce stigma associated with BH conditions and help-seeking.

Main Methods:

• Highmark Health collaborated with Spring Health to develop and implement a comprehensive mental well-being (MWB) program.
• A phased rollout involved technical integration for member portal access, utilizing a structured intake process with self-assessments for personalized care plans.
• Interventions included digital wellness, care navigation, virtual/in-person behavioral care, routine self-assessments, medication management, and 24/7 crisis support.

Main Results:

• The MWB program achieved an average wait time of less than two days in 2025.
• Members with moderate-to-severe depression and anxiety achieved remission in approximately four and five appointments, respectively, in 2024.
• In 2024, 78.5% of approximately 51,000 MWB-enrolled members engaged with BH services for the first time.

Conclusions:

• The MWB program demonstrates significant success in reducing wait times and improving access to behavioral health services.
• The program shows positive clinical outcomes, with notable remission rates for depression and anxiety.
• The initiative effectively engages members, including a substantial proportion seeking BH services for the first time, indicating reduced barriers and stigma.