This article is sponsored by evolvedMD. In this Voices interview, Behavioral Health Business sits down with Erik Osland, CEO of evolvedMD, to talk about the mental health crisis today and how the current system is failing its stakeholders. He dissects the key problems with the existing behavioral health system and explains how integration with primary care can help providers overcome significant challenges. He also maps out the steps this system and its stakeholders can take to tackle the mental health crisis and meet the growing demand for quality care.
Behavioral Health Business: What life and career experiences do you most draw from, in your role today?
Erik Osland: I’ve spent my entire post-undergrad career in the health care arena, predominantly on the med tech and device side—what I call the physical health side of the spectrum. About 10 years ago, I had my first experience in the mental health space through my father, who was chronically ill with a number of complex conditions. He was on 17 medications and slept about 18 hours a day. Beyond being a sick man from a physical health perspective, he was also clinically depressed and struggled with mental health challenges at the end of his life.
As a family, we worked hard to get my dad mental health resources. He was a Medicare beneficiary, and despite our efforts, we really struggled. That frustration stuck with me. I had experience plugging products and services into primary care and felt that the setting could better serve people like my dad and others in my family—without the barriers, stigma and challenges they faced. Ultimately, in 2017, we started this business with a focus on integration.
Much of what I’m doing today stems from the frustration of navigating a broken system and the experience my dad had. Despite having resources, time and energy, we couldn’t get him the care he needed during a critical time in his life. We set out to address that here in our home state of Arizona. Today, we’ve made a meaningful impact and continue to build on that momentum.
What problems do you see within the existing behavioral health system?
From a general perspective—whether it’s physical health or behavioral health—we don’t have a health system; we have a sick care system. Specifically in behavioral health, we tend to wait to provide resources and tools to patients until their symptoms are severe, their acuity is high or their conditions have become highly complex.
The system today focuses heavily on our highest acuity patients, those with serious mental illness (SMI), and high-cost patients. While these individuals absolutely need care and support, if we want to transition from a sick care system to a true health care or whole health system, we must shift our services upstream. This means removing barriers between physical and behavioral health and creating systems where most patients can easily access care—whether through digital, virtual, in-person settings, or more robust services when needed.
What we do from an integration perspective is designed to help with this, but fundamentally, the biggest issue is that the system hasn’t been designed to keep people healthy. It’s only structured to treat those with the highest acuity needs. To address this, we need to focus upstream, providing people with tools and resources to manage their overall health—especially their mental health.
How can integration with primary care solve some of these problems?
Fundamentally, primary care is where the vast majority of people in our community receive care. If you look at the data around mental health prevalence in primary care, roughly 30% to 40% of patients who come in for a physical health visit have an underlying mental health need, and the vast majority of those patients never receive care.
Today, the system is designed so that when a PCP identifies a mental health issue, most primary care providers don’t have behavioral health resources on-site to address it. Instead, they typically refer the patient to the community, saying, “Good luck, and let me know how it goes.” The result is a very low success rate—under 20% of patients referred from primary care actually complete their first behavioral health visit.
How does integration solve this problem? First, it allows the primary care physician to identify an issue and then immediately walk the patient down the hall to a behavioral health specialist, enabling same-day care. This approach eliminates much of the stigma and logistical barriers patients face when seeking services in the community. From a cost perspective, it’s also more affordable. Patients typically don’t pay a specialty copay to see their primary care provider, and the same applies to integrated behavioral health services. This model essentially brings care directly to the patient’s front door.
Around 80% to 85% of the patients we see can have all of their needs met right there in the primary care setting. For those with higher acuity needs, we help them navigate the system to ensure they reach the right level of care, with a provider in their geography who accepts their insurance—and, most importantly, has capacity. It’s not acceptable for a patient with acute needs to wait 12 weeks to see a psychiatrist. Integration addresses this by streamlining the process and ensuring patients receive timely care.
Which key stakeholders will feel the greatest impact, and what would you tell them if they were right in front of you?
The first thing we have to acknowledge is who’s feeling the brunt of this impact today. It’s certainly the patients who can’t access care and their families, and then downstream into the communities. But this also heavily impacts our primary care providers. Burnout is at an all-time high because they don’t have the time or resources to manage the patient panels they’re currently assigned. Without those resources, they’re frustrated, and that frustration leads to burnout as patients get sicker and sicker.
What would I tell those stakeholders and others involved? First, we need to alleviate the pressure on primary care providers and core systems by giving them the resources they need to manage the patients showing up in their offices. Second, we need to engage stakeholders at the health system and payer levels to ensure they understand the problems the system has created and shift resources to support clinicians and their communities.
Finally, if we’re talking to payers, we need to address the incentives built into the system. We have to create incentives not only to expand integration, but also to encourage providers to help patients get better. That means focusing on measurement-based care and outcomes. If these programs are effectively delivering quality care and downstream benefits, we need to incentivize them appropriately.
I’m certainly myopic, but I think integration is the centerpiece of the future of behavioral health. The data is clear: integration not only provides better outcomes but also lowers the total cost of care to manage patients. It increases patient satisfaction and has been shown to decrease burnout among primary care providers. Yes, this is the future. We’re heading in that direction, and I’m bullish that these activities will continue to accelerate in the years ahead.
What are the next steps for the system and its stakeholders coming out of this conversation?
When I think of the stakeholders across all of behavioral health, we need to start having a community-wide conversation about adapting to better focus on aspects that will shape the future of health care—specifically around measurement-based care. The idea of building a lifelong patient panel and maintaining that relationship indefinitely isn’t realistic given the current challenges. Instead, we need to focus on identifying targeted outcomes for patients and guiding them to that point.
The goal should be to get patients to a place where they can be discharged from the panel, return to their lives and communities, and use the skills they’ve learned to better manage their physical and mental health. If you look at traditional mental health today, we have to create off-ramps from services. This means delivering an actual, measurable outcome for patients and transitioning them to a lower level of care so we can take on new patients and keep the cycle going.
For traditional behavioralists, it’s time to shift towards data and outcomes—the market is ready for that. For payers, we need them to prioritize coverage of integrated care. Today, roughly 30 states cover collaborative care under Medicaid, which is progress compared to five years ago, but it’s not enough. We need all 50 states to come on board with reimbursement mechanisms that reflect the true cost of delivering these services.
In some states, like Illinois, Medicaid rates are so low that sustaining a program through traditional financial means isn’t feasible. We need those rates to rise to a reasonable level to make these programs viable. It’s about getting payers and health systems to adopt and sustain these services, and shifting the traditional behavioral health system to meet the growing needs ahead. What we’re doing today simply isn’t enough to address what’s coming.
What’s on the horizon for evolvedMD and its clients?
It’s an exciting time for us. Since 2017, we’ve done a lot of work to build out our model, refine how we deliver care and establish a strong reputation. Looking ahead, we’ll continue to see growth in our core integrated collaborative care model. From day one, we’ve been committed to the belief that the best behavioral health care happens in person, where patients and providers can sit together and truly understand the patient’s needs.
Within an integrated care setting, we also think it’s vital for our providers to be on-site, engaging as team members with primary care providers. You’ll see us continue to focus on this, launching new customers in existing markets. We believe density is key—currently, in Arizona, we have 50% of the primary care market under contract to integrate services. We’re now operating in five states, and in the year ahead, we plan to expand across the U.S.
We’re also doubling down on care navigation, ensuring patients who need more robust care are connected to those services efficiently and quickly. On the business side, we’re excited to launch new service lines. Next year, we’re focusing on a corporate practice of medicine with innovative approaches to psychiatric medication management. We’ll also develop systems to support care transitions for patients leaving inpatient facilities, ensuring they have ongoing resources when they return to the community.
None of this is possible without our clinicians, who deliver these services in the community. What I’ll be most proud of when all is said and done is how we’ve built out our workforce. Our ambition is to become the best developer of integrated clinicians in the country. We’ve invested heavily in their development, including launching a 24-month Collaborative Care Leadership Development Program that builds clinical and leadership skills. We’ve also implemented incentives like a $10,000 student loan repayment to support our team.
Everything starts and ends with our people. If we can’t recruit and retain great clinicians, it’s hard to sustain the impact we’re making. They are the heart of what we do, and we’re incredibly proud of them.
Finish this sentence: “In the behavioral health space, 2025 will be defined by…”
…significant change and disruption within the traditional mental health space.
This change and disruption are necessary if we want to avoid the reckoning we’re facing with the mental health crisis. We all know there aren’t enough providers to meet the growing demand, and these workforce issues will continue to persist. If we don’t start redesigning the system to address these challenges, the situation will only worsen. We need to embrace change and disruption—and that’s not necessarily a bad thing.
On a more specific level, I think we’ll start to see a shift toward integrated care, driven by insurance providers and payers. I expect payers to begin applying pressure on reimbursement rates to force changes in the market. For instance, the pendulum has swung too far toward virtual care. Right now, about 70% of services are delivered virtually, but many stakeholders and payers aren’t satisfied with that balance. I anticipate a shift to bring in-person care back to at least 50% of services. This shift is already underway, but it will become more prominent as payers demand data and outcomes to justify care models.
It’s no longer acceptable to assume that simply seeing a patient for six months, a year or three years will deliver the desired outcomes. Measurement-based care needs to be implemented across the board, and I think payers will start tying reimbursement to these metrics. All of this aligns well with integrated care. Our model is designed to focus on in-person care, flexing to virtual when appropriate, and prioritizing collaboration and outcomes.
Editor’s note: This article has been edited for length and clarity.
evolvedMD is leading the charge to change the behavioral healthcare system by focusing on three elements: it must be integrated, it must be comprehensive, and it must be collaborative. It’s a radically different approach to care, one that is focused on delivering superior patient outcomes.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
