The financial and operational pressures facing behavioral health providers are intensifying, with the list of headwinds including rising business costs, regulatory changes and more.
Above all, reimbursement- and payment-related challenges are emerging as the dominant concern among industry executives, according to a recent survey from Behavioral Health Business.
To better understand the trends, challenges and opportunities shaping the industry in 2025, BHB collected responses from 108 professionals employed by organizations that provide behavioral health services. More than three-quarters of those respondents held executive, vice president or director-level roles, offering a leadership perspective on the industry’s most pressing issues.
Nearly half of all executives surveyed identified reimbursement and payment issues as the single greatest overall challenge confronting the industry.
This was a sizable increase from 2024, when the same question yielded a slightly lower level of concern.
The growing apprehension underscores the persistent struggle behavioral health providers face in securing sustainable payment rates across payer types, with many citing declining reimbursement levels from both commercial insurers and government programs. Delays and administrative hurdles in claims processing are also becoming more common, sources have previously told BHB.
In line with those sentiments, 58% of executives surveyed by BHB pointed to payer rate reductions and minimal rate increases as the most significant financial strain for providers in 2025.
These pressures threaten to erode service capacity and quality at a time when demand for behavioral health treatment remains strong. A high-profile example of such payer trends is Optum.
In December 2024, investigative newsroom ProPublica reported that UnitedHealthcare was strategically limiting individuals’ access to autism treatment. About a month earlier, another outlet reported that Optum cut its rate for therapists practicing with two large digital practice enablement platforms.
“We’ve noticed increased payer scrutiny of treatment dosage levels and more record reviews that slow/prevent payment and increase the likelihood of recoupment,” Brad Zelinger, founder and CEO of Stride Autism Centers, told BHB at the end of 2024. “As access to ABA increases and payers try to manage their spend within the segment, I anticipate this trend will continue.”
Beyond reimbursement, staffing shortages persist as a major industry challenge, with 31% of respondents in BHB’s survey identifying workforce constraints as a primary headwind.
Hiring and retention difficulties are particularly pronounced in specialized areas such as autism therapy, psychiatry and substance use disorder (SUD) treatment. Low reimbursement rates exacerbate the issue, making it difficult for providers to offer competitive compensation and maintain a stable workforce.
As financial constraints mount, some industry leaders have pointed to value-based care as a potential alternative to traditional fee-for-service reimbursement.
However, the BHB survey suggests that widespread adoption of such models remains elusive.
In fact, a whopping 65% of survey respondents reported that none of their organization’s revenue is derived from value-based care arrangements.
In contrast, only 5% said that more than half of their revenue comes from these models. An additional 3% indicated that between 41% and 50% of their revenue is tied to value-based contracts.
While a handful of organizations have successfully navigated the transition to outcome-based payment models, broader adoption remains hindered by structural and operational challenges, BHB has previously reported.
Payers have been slow to implement behavioral health-specific value-based arrangements, and providers continue to grapple with the complexities of defining and measuring outcomes in a way that aligns with reimbursement structures. The upfront investment required for data infrastructure and analytics further complicates the shift, making it an impractical option for many.
The survey findings reinforce the considerable uncertainty surrounding the financial outlook for behavioral health providers in 2025.
Reimbursement issues remain the foremost concern, staffing shortages continue to weigh on operations, and the industry’s shift toward value-based care has been sluggish at best. Without substantive changes in payer policies and reimbursement frameworks, many providers may find it increasingly difficult to sustain operations while maintaining service quality, BHB’s survey suggests.
As the sector navigates these headwinds, providers, payers and policymakers will need to collaborate in crafting sustainable solutions.
In the interim, behavioral health organizations must seek operational efficiencies, explore technology-driven care delivery models and reassess strategic priorities to withstand the growing financial strain.
BHB conducted its survey between Jan. 14 and Feb. 20.
