Over the past decade, value-based care has transformed primary care and other physical health specialties. When providers are supported and aligned around shared goals, outcomes improve, innovation accelerates, and patients benefit.

The results speak for themselves: In 2022 alone, the Medicare Shared Savings Program (MSSP) generated $1.8 billion in gross savings, with over half of ACOs earning shared savings. Programs like Bundled Payments for Care Improvement (BPCI) and ACO REACH have improved quality, reduced costs, and sparked nationwide innovation.

Behavioral health, however, is still lagging behind.

It’s not that behavioral health can’t succeed—it already is in many places. Models like Certified Community Behavioral Health Clinics (CCBHCs), Health Homes, Medicare’s Behavioral Health Integration (BHI), and Medicaid programs such as CalAIM and North Carolina’s Tailored Plans are making a difference. These initiatives have expanded access, strengthened care coordination, and delivered measurable results—especially for individuals with serious mental illness.

Most importantly, they represent action. They’re proof that progress is possible. Now we need more: more pilots, more investment, more innovation—and a deeper commitment to build on what’s working.

We don’t need to wait for a national blueprint. System-wide transformation starts locally and grows with aligned energy. Large systems and small clinics, specialty SUD providers and virtual-first platforms—all have a role to play. Collaboration doesn’t require uniformity. It requires participation.

So why hasn’t momentum scaled?

Because the level of investment that fueled value-based success in physical health hasn’t been matched in behavioral health—not by CMS, and not by payers.

Primary care transformation didn’t happen by chance. It was built on infrastructure support: care team funding, data tools, EHR upgrades, analytic capabilities. CMS and payers invested up front—and providers delivered results.

To be fair, some critics still question the savings from CMS programs. And yes, some initiatives fall short. But many were designed to test bold ideas, and that’s the point of innovation. What those critiques often overlook is the broader return: deeper payer-provider partnerships, stronger focus on social drivers, improved data systems, and progress toward the quintuple aim—better outcomes, lower cost, improved patient experience, provider well-being, and health equity.

Behavioral health deserves that same momentum.

Here’s why it matters: Behavioral health isn’t siloed. It shapes physical health outcomes and drives total cost of care. People with behavioral health needs account for nearly 60% of spending among those with chronic medical conditions. When left unaddressed, mental illness leads to higher ER use, longer hospitalizations, and poorer outcomes across the board.

And yet, only one in three adults with a mental illness receives treatment.

That’s not just a gap—it’s a system failure.

But the ROI is clear.

Treating depression improves adherence to medications for other conditions. Addressing substance use reduces avoidable utilization. Integrated care models consistently reduce total medical costs—particularly for people managing both physical and behavioral health challenges. CMS itself has named behavioral health integration as a critical lever to improve outcomes and lower costs.

Still, the field faces real headwinds: workforce shortages, access barriers, reimbursement inequities, care fragmentation, and crisis system gaps.

Value-based care isn’t a silver bullet—but it is a lever for solving these challenges. Programs that fund team-based care, reward integration, expand telehealth, and support culturally competent engagement strategies can reduce strain, expand reach, and close equity gaps. Outcome-based reimbursement—not just volume-based payment—is key to finally achieving parity with physical health.

These aren’t theoretical concepts. They’re actionable strategies—if we choose to design, fund, and scale them.

Yes, attribution is hard. Metrics are evolving. Data is messy. But these challenges aren’t new. Physical health overcame them through shared commitment and bold steps forward.

We’re not short on ideas—we’re short on momentum.

Waiting for the perfect model or perfect alignment is a recipe for paralysis. And in behavioral health, we can’t afford to wait.

Federal support matters, and CMS has taken important steps. But recent political disruptions make one thing clear: transformation won’t be handed down from Washington. It will be built—by providers, payers, and communities ready to lead.

If you’re waiting for a perfect solution, stop. Behavioral health doesn’t need perfection. It needs action.

About the author:

Lindsey Crouse Mitrook is Senior Vice President of Payer Contracting & Strategic Partnerships at Valera Health.