This is an exclusive BHB+ story
As fragmented as the behavioral health space may be, achieving a return on investment is something providers, payers and patients generally agree on.
Yet, proving ROI looks different just about everywhere, and what it means to different stakeholders can vary. What matters most, though, according to Dr. Mill Brown, chief medical officer at Spring Health, is measuring ROI through health spend, data and outcomes.
New York-based Spring Health is a virtual mental health provider that offers employee assistance programs (EAPs) and mental health benefits for employers and health plans. As a company, it utilizes several different data points to measure ROI from clinical screening data, presenteeism vs. absenteeism, and other functional baselines.
Brown has more than two decades of experience working in mental health care with a focus on ROI data. Research he led at Spring Health earlier in 2025 revealed that high-quality mental health care can lead to a reduction in total health spend for patients – including medical spend. This often yields an ROI of two times the investment within the first year, Brown explained. Yet proving ROI again and again requires providers to invest in comprehensive electronic health records (EHRs), an understanding of health economics and an emphasis on measurement-based care.
In this BHB+ TALKS conversation, Ashleigh Hollowell, reporter at Behavioral Health Business, dives into a discussion with Brown about the ongoing quest to prove ROI to all stakeholders, what works well and the barriers that may prevent a more robust approach to doing so.
Ashleigh Hollowell: Good morning, BHB+ members. Welcome to another episode of BHB Talks. Today, I am joined by Dr. Mill Brown, chief medical officer at Spring Health. We’re going to be talking about measuring the ROI of high-quality mental health care. I am your host, Ashleigh Hollowell, Reporter at Behavioral Health Business. Dr. Brown, how are you doing this morning?
Dr. Mill Brown: Doing great.
Hollowell: Great. In your own words, I’d love to hear a little bit. Tell us about Spring Health, and how long you’ve been there, and walk us through your background. Then we can dive into some of the meatier substance of this conversation.
Brown: Glad to. My name is Mill Brown. I’m the chief medical officer at Spring Health. I’ve been there for over six years now as the lead doc for the team. Prior to that, I spent 21 years in the Army as an Army psychiatrist. During that time, I worked as a psychiatry training director and at one point as a staff doctor.
Then also, the last decade or so of my career, I worked with the Army’s medical leadership to start to rebuild our mental health care system. This was starting in about the 2008 range, when we were at war with Iraq and Afghanistan. A lot of soldiers were coming back with PTSD and other mental health issues, traumatic brain injuries.
We received a lot of extra funding from Congress, literally $700 million a year to improve mental health care delivery. I spent the last decade or so as part of that core medical leadership team working to rebuild our mental health system from the ground up in a new way, to do measurement-based care, to really standardize the data that we were collecting and really try to drive quality care in many different ways.
I learned a lot of lessons there, and so I try to bring those to Spring Health, and what we’re doing today with Spring Health with the precision care-type approach that we try to use.
Hollowell: There’s a lot of expertise to draw on from this conversation. I just want to remind our audience, if you have any questions that you would like asked during this chat, feel free to send them directly to me through the Q&A function below, and we will incorporate those into the conversation today.
Dr. Brown, I want to get into ROI. ROI can mean different things to different stakeholders: employers, payers, providers and patients. How do you define ROI in behavioral health?
Brown: For us at Spring Health, we provide a comprehensive mental health solution for tens of millions of covered lives, both an EAP, employee assistance program side, but also on a health plan side. We’ve worked with health plans and employers in many different ways in looking at ROI.
For us, we look at ROI in several different ways. With our employer clients, we look at it from maybe a workplace lens where we look at absenteeism, and presenteeism, and retention-type issues.
Then on the health plan side, many of our employers are either self-funded – so they’re paying for their own health insurance – but also with our health plan partners, we look at total health spend. When you change how mental health care is delivered, when you radically change how access to high-quality care can happen, we try to look at ROI from a total health spend cost. Not just mental health, but also medical spend, and what happens there.
Then there are others who look at maybe the value of investment. They think about the impact that they’re having on their members who are receiving care. Sometimes it shifts depending on what our customers want, and think, and how they’re thinking about ROI internally within their own teams.
Hollowell: You’ve been working on measurement-based care and ROI for a lot of your career. What parts of your career specifically would you say have most informed or influenced the way that you think about ROI today?
Brown: When we were starting to rebuild the Army’s mental health care system in the late 2008 to 2010 range, our medical leadership wanted us to change how we thought about mental health care as a way of getting away from our views as the only thing that they looked at.
Even in our direct care system within the Army, we had several thousand full-time providers across 60 bases around the world doing several million appointments just in mental health care every year. It’s a very large direct care system, but it’s like a single-payer health system. We actually get a set amount of money for that direct care system from the Pentagon. We had to use those dollars very well. We had to think about how we’re going to use these dollars for the maximum effect for soldiers and their families, whom we actually care for.
Looking at it there, we had to think about things. What’s really, probably, informed me in a lot of ways is that, as a doc, we always think about things from an individual care perspective. It’s that doctor, and that patient, and how do I maximize the effectiveness of my efforts for that person.
Then, at a population level, when you think about population levels, you think about other things. You might think about access to care, what types of programs are available, how are they going to find them or not find them? Who is actually using them? How are you going to pay for those in different ways?
Trying to take that individual approach, but also look at that population approach on the Army side, I think really informed a lot of what we built in the Army, but then also how we think about things in the civilian sector, also as we work with large employers, and large health plans.
Hollowell: As we’ve mentioned just a few moments ago, ROI can mean different things to different stakeholders. How do you measure and communicate the value of mental health programs to decision makers who are really focused on the financial bottom line? What kind of strategies have worked for you?
Brown: For us, we’ve tried to build our care processes in certain ways. When someone comes in and makes an account with Spring Health, we are also trying to find the right care at the right time for the right person.
We collect a bunch of different data points when they come in. There’s a cost to that at some level, but we think it’s worth that cost to really get that clinical screening. We look for safety screening in a lot of ways. Then we also look at their functional baseline. We try to look at productivity in some ways. We try to look at how you are functioning, not just with clinical symptoms, but also how you are working at home, how is school going, how work is going, these different social domains, and try to get that baseline, then we can think about ROI in various ways.
We also often get census files from our employers, so we know who has access to the benefit. Also, when they lose access to the benefit we can look at things like retention, because we see people get hired, and we see people leave their jobs also. We can use that data to look at different things. In our 2022 JAMA paper, we looked at clinical outcomes at scale, but we also looked at presenteeism, absenteeism, and retention in that group.
Basically, it showed that you can have massive effects when you deploy a coordinated quality system of care with radical access to care in two days or less. When you do that and you have a high-quality care system, we can look at those type of things.
We’ve also shown in 2025 in a couple of papers, one in JAMA, one in the Journal of HEOR, that when you look at health spend, you can look at total health spend, and work with the employers to look at their claims datasets before deploying a solution like Spring Health, and then afterwards. Then, looking in very technical ways and very sophisticated ways at what does that actually do to mental health spend, but also their medical spend?
You can start to show health spend changes with really good, quality mental health care in ways that I think a lot of people working in the health plan space have always thought might be true. For example, if you treat their mental health care, they might take care of their diabetes better. Their chronic pain might be easier to take care of. Their musculoskeletal issues might take less medical spend to get them back to that functional state. Really trying to bring in medical and mental health spend, I think, is important when looking at ROI in many ways.
Hollowell: I would love to hear a little bit more about the JAMA paper that you were mentioning from earlier this year. Were there any surprising things to you that came out of that, or anything unexpected?
Brown: Like a lot of things, I think if we look at it, and what we think is likely true, it showed those things that we thought were true, were true. Then, when you look at the magnitude of effect, I think it’s probably the biggest surprise piece.
We knew from the Milliman studies, from the late 20-teens that came out, and they basically looked at health spend costs of the top 20 medical issues that are going on in people’s lives, and then looked at those with a mental health diagnosis, and those without.
What does that do to the medical spend, not even the mental health spend? If you have hypertension, you have diabetes, you have musculoskeletal issues, you have chronic inflammatory diseases, that medical spend component would increase three to six times for those who had a mental health issue, versus those who did not have a mental health diagnosis in their claim set.
We always thought, if I can treat that mental health disorder, maybe I can decrease that medical spend, and how much can we actually impact there? What we showed in our 2025 paper is, we were able to get claim sets for several employers in that first JAMA paper, and then show the differences in medical spend within the first program year. I think the average length of time in care was about six to seven months for the people during that first program year, and then, looking at what those differences were.
Basically, what we saw was that we could take care of more people in an outpatient setting, and it could decrease the inpatient mental health setting pieces. The mental health spend was about the same pre- and post, but more people were able to access mental health care.
Then, for those same people, what we basically saw is that the medical spend dropped quite a bit, and the more chronic medical conditions they had, the more benefit there was, which again follows our intuitions.
We were basically able to show that you can save on a net basis after paying for the mental health care, an increase in outpatient spend on a net basis, you would still get over two times ROI in that first year.
I think that’s the other piece that was surprising, even within one year, you can actually get a net-spend benefit by decreasing total health spend when you provide high-quality, fast access to mental health care.
Hollowell: Right, and two times, that is pretty significant for any health system, any company in health care at all.
Brown: Right. For sure.
Hollowell: What are some barriers that you see organizations routinely face when trying to demonstrate ROI in mental health?
Brown: It’s probably a few things. One is, do you have a data collection system that collects the data that you actually need? Do you have clinical outcomes you can track on a regular basis with a large proportion of the people that you actually treat?
Doing measurement-based care is a key thing that we’ve worked very hard at. It’s actually easy in concept, but hard to execute at scale. A lot of organizations work at that and struggle with that and are always trying to do better.
Trying to get clinical outcomes to see who’s actually getting better, who’s not, and can you relate that to medical spend changes? I think trying to get access to claims data when you’re trying to do health spend ROI analysis is extremely hard.
There are a lot of employers that – for good reason – are very careful with sharing that data. You have to work very closely with them to figure out how are you going to look at this data? How are we going to protect employee and family member information? Can we get enough of that access to data even before starting any solution, so you can get a good baseline, and then compare the active treatment after baseline when you’re doing cohort looks?
Trying to do that kind of work is really hard, and a huge barrier for probably most organizations, including ours. It makes it challenging. We’ve been able to convince some employers.
Our second paper in 2025 with the Journal of HEOR, we had over 20 different employers that were able to get claims data to do that health spend analysis, but that’s really hard data to collect. It takes a lot of effort by a lot of people to do so. Then there’s a cost with trying to chase down those claims.
Lastly, you need the sophistication of your data teams and your research teams who really know about health economics data, and how to do those really well, and robustly, because the variability in the claim spend can be super challenging to manage, and how you compare one cohort to another. A lot of it comes down to doing proper cohort matching, and that gets really challenging and hard in many ways. You need people who really understand health economics data to be able to get there.
Hollowell: From your perspective, what innovative care models and approaches hold the most promise for improving patient outcomes, and also simultaneously delivering really robust measurable ROI?
Brown: In a lot of ways, like I was talking before about the population piece, some of the innovation comes in how do you really solve the core basic issues of care? Can you get people access to care for the right type of person? Can you find them therapy? Can you find them medication, evaluation and management support when they really need it? Can you encourage them to access those when they actually need it, and not have to wait 6, 8, 12, 24 weeks before they can find somebody?
Because people’s willingness to engage kind of waxes and wanes very fast. If you don’t have ready access to care, you’re going to miss a whole group of people.
We saw that in the Army when we doubled the number of mental health providers. We still had access to care issues because there’s this full shadow population who generally have a hard time accessing care. Even when you bring in access, you get a lot more people out of the shadows that are wanting access to care, but they can never find it.
When we go into care, we usually find upwards of 30% to 40% of additional people engaging in mental health care needs than compared to their usual baseline prior to implementing Spring. There’s that big shadow population. What kind of programs can get those people access to care so you can actually get them into care?
Then, even within that, you have to get them to stay in care long enough to have a chance to get better. No matter what innovative thing you do, trying to get them to stay engaged long enough to even have a chance to get better is critically important for any program.
There are some really cool things going on. In the neuromodulation space, in the home biofeedback space, I think there’s a lot of interest in there. Then the technologies that can really personalize and be dynamic with either self-care, or wraparound supports to traditional human-based care, are going to be really interesting to see how they can bring more consistent outcomes to more types of people with a lot of different backgrounds, and problems that they bring to care.
How do we support all those different types of groups in a more personalized, dynamic way than we could before? With a lot of work on the AI, and a lot of personalization work that’s going on, it’s going to be really interesting to see.
Hollowell: I’d love to expand on that. I think we’d be remiss if we didn’t bring AI, and technology into the conversation. How do you think those tools will evolve ROI further over time? Where do you expect to see the conversation around measurable ROI in behavioral health going with these new tools, in maybe three to five years from now?
Brown: I think they’re going to be able to help us really figure out, and collect a lot of information on the front end in more naturalistic ways, and then be able to figure out what is going on with the person. Maybe get to a better diagnosis on the front end by collecting a wider set of data very quickly, where traditionally it was very hard to collect that data, then try to route them to the right type of care.
You have people accessing self-help support that really need more clinical care, and you probably have the reverse, too. People accessing clinical care who could probably do just as well with some type of self-help support tools that are highly evidence-based. That data collection, diagnosis and routing to the initial phase of care.
Then there’s a lot of work that I think AI tools can do to keep people engaged in care in that wait space in between appointments, because the modal number of mental health appointments across the U.S. is typically one. They come in once, and then many people drop out. How do you get them to stay in care when they first try? How do you get them to have a good first experience, but then also stay engaged to have that chance to get better?
Then throughout care, there’s a lot of opportunity for AI to help with in-session and between-session work, so our members can take, and patients can take what they’re working on in-session, and try to practice it, and apply it to the outside real world. That’s usually a challenge.
If we can build tools that help people do that more often, and more consistently, and get feedback about that in-between sessions, then I think there’s a big chance we can really increase the efficacy of a lot of our efforts across many more people. That has the potential to bring down the cost of care.
I try to encourage teams not to look at the individual care moment, like the cost of an individual therapy session, but what’s the total cost of care for that depression episode? What’s the total cost from getting them started to getting them fully well? I think there’s going to be a lot of opportunity there.
Hollowell: Maybe say a little bit more. How will that bring down the cost of care overall?
Brown: If you think about a typical evidence-based therapy treatment, it might take 8 to 12 to 16 sessions, but you can do that in maybe 70% of those sessions, but have AI tooling around that, so you get even better outcomes than what you traditionally would get.
Then you might actually see that ROI actually get better. If you think about the value components, it’s basically the magnitude of the outcome over your total cost. If you can shrink the human cost a little bit, and get them better at it, there’s plenty of work for therapists to do. It’s not like getting rid of therapists. It’s really about, can we get them better? Can we get someone better? Go have a trial of life, and let that therapist go take care of somebody else again.
Instead of 30, 40 sessions, can you get them better in a routine amount of sessions with evidence-based care? That would decrease the cost per successful care episode, and really get people better on the top part of that equation to give a higher outcome at a lower total cost.
Then you’re really starting to impact the cost component of things, but you’re also getting more people better. Then your medical spend savings on the other side actually gets better.
If you’re looking at the population medical spend, it’s really how much savings per person times the percent of the population you’re actually impacting. If you can affect both of those numbers at the same time with the advent of a little bit of AI tooling to support and supercharge care, you’re going to really drive value in many ways.
Hollowell: Right. I want to pivot just a little bit. How do you navigate the tension between cost containment, and providing the highest quality of care in the behavioral health space?
Brown: I think we’ve tried to look at cost containment in that ROI sense. If you look at just cost containment, often cost containment can mean decreasing access to care, or finding the cheapest care possible without even thinking about quality.
Cost containment can be pennywise, and pound-foolish in many ways, but you also don’t want to be spending money on ineffective care as a health plan, or as an employer. You’re trying to figure out what is the right way to think about those cost structures.
For us, we really try to look at, can we get access to care for those who really need it? We try to encourage people to engage care when they need it, but also to engage other types of support services, maybe when they don’t present as really needing clinical care in the moment. Trying to route them in the right way is a really important cost containment strategy without impacting the actual individual need in the moment.
Then, really looking at the high-quality care side, what are the things that help people get better? When you try to do it at scale, like us at Spring Health, we have tens of thousands of providers, it’s hard to go do evidence-based training to say, “Okay, here’s how to do CBT. I’m going to really change providers’ actual behaviors.” It’s really really hard. Just like any of us, to change our own behaviors is hard. The same is true for providers in many ways.
For us, when we think about quality, we’ve also invested a lot in looking at the outcomes of every provider. If I can track clinical outcomes across my whole system, I can figure out which providers are actually good at treating which type of problem areas. Then I can try to route people and match people to those things.
If you have a system with good measurement-based care and tracking clinical outcomes across the course of care, then I can figure out what providers, not just what they say they’re good at, but what they’re actually good at. I can do a lot of high-quality care things by routing someone with, say, someone who screens positive for PTSD. I can figure out on my network who’s best at treating PTSD, and try to route them to that person. If I do that well over and over again, I’m going to increase the outcomes of the entire group. I can really try to work on high-quality care that way.
I’d say the last thing is really having them all on one system. For us, we’ve built our own EHR. All of our providers have to use our tech. They can’t just document in their own private practice so I can’t see what they’re doing. They have to engage with our member-facing tech, and provider-facing tech so that they can sync together.
If I’m providing AI tooling to a patient, or a member in our system, the provider can also see that because we’re all on the same tech solution. Trying to do that gives me so many opportunities to do high-quality monitoring, redirection, and figuring out which providers need extra support, which ones are doing great in so many different ways that otherwise wouldn’t be possible in a large group practice-type environment.
Hollowell: On that note, we often hear how behavioral health is extremely fragmented as a segment of healthcare in many many ways. Do you think that this fragmentation, even when it comes to technology, and EHRs, or lack thereof, as you spoke of, does that make ROI harder to prove for some providers, would you say?
Brown: It’s harder to prove for providers because many of them are not on a great tech system. If they are on an EHR, depending on what type of EHR they’re on, some of the larger EHRs don’t really cater toward mental healthcare. They don’t really have a good way of doing measurement-based care. Some of the newer ones do, which is great to see, but many of them are either writing notes by hand on their own, and really keeping things in their private practice, or they’re using EHRs that have a hard time helping them with measurement-based care. That’s really hard.
Then, if you’re a single provider trying to say, “Here are my outcomes,” there are health plans that are trying to work with them to either provide tooling or to provide pathways for them to get rewarded for better care.
That’s even really hard on the health plan side. I think that’s why we’ve seen a lot of companies develop, and try to bring folks together into one type of tech solution to help, one: improve measurement-based care, but also bring that data to health plans to say, “Hey, this is the type of work we’re actually doing.”
The other big problem was that mental health was excluded from all of the EHR incentives in the past. There are a lot of us trying to talk to current policymakers about, l”Hey, can we incentivize mental health providers to adopt any EHR technologies, and to help them with those costs, because they’re not insignificant?”
There are a lot of people who have a need to adopt EHRs, but need financial support to make that leap and to really get it done.
Hollowell: For those that might not be there yet with an EHR that supports behavioral health measurements, or any of that tooling right now, but they’re still trying to prove, and track ROI, what would you recommend?
Brown: I’d rather recommend looking at various services. You don’t have to make the whole leap at once. There are several tools out there now that provide measurement-based care tech capabilities to a private practice that you can dip your toe in, and go look at those and try them out.
You can also just, if you’re trying to figure out how to do measurement-based care in sessions, there’s always the pen and paper process. You can use the outcome rating scales that are very simple to use. You can use PHQ-9s, GAD-7s. You can use PCLs for PTSD. There are simple ways to do it. Many of those are in the public domain or allowed to be used for private practices. There are really low-cost barriers there, but just trying to start to do it in your sessions.
I actually think doing measurement-based care in-session is, there with some of the tracking. What it also does is allow members in a very structured way to tell providers where they’re at. We’re actually not that great at it on our own. A lot of research has shown that we’re not good at detecting when people are doing worse.
Our patients often try to take care of us as therapists and not tell us the truth. They might feel ashamed that they’re not getting better. There are all kinds of barriers getting in the way for them to tell us that maybe we need to try something different.
I’ve seen that over and over again in my career, those barriers that are in the way of patients telling providers what’s really going on. Measurement-based care gives a venue to do that in a way that, oftentimes, they can say, “Hey, I’m not getting better,” or they may not even know. Having a tool to track can really help you figure out, “Oh, this person is actually not getting better in the way that they want to. Let’s try something different.”
Hollowell: In that same vein, when ROI isn’t always immediate for many conditions, what advice do you have for behavioral health leaders who are trying to advocate for investment in care?
Brown: I think the big thing on the health plan side is really trying to get health plans to think about not just mental health spend over here, and medical spend over here, but think about it overall. Really thinking about it as a total health spend picture.
Probably one of the things that really hurt our field over the last couple of decades was mental health being carved out from the rest of medical spend. One, because of just what that does to create all kinds of unforeseen barriers between medical and mental health. It also split the cost structures and the spend structures even inside health plans, where they often look at, “Okay, I’ve got to go find ROI just within mental health spend.”
That’s even harder to do than when most of the benefits are on the medical side. It’s really trying to find ways for mental health leaders to really articulate, “Hey, mental health actually affects medical spend.” Getting people to be aware of that is going to be really important to set up the foundation, at least on how people think about things, to get it to that foundation where it’s total health spend that really matters when you’re looking at ROI, not just mental health spend.
Hollowell: Right. Speaking of things that are hard for the mental health field do you think lack of parity enforcement in behavioral health makes ROI harder to prove broadly?
Brown: It does in some ways if plans are not as compelled to figure out what those financial barriers are. One is around financial barriers, and the other is around access to care in appropriate ways. Then, in some ways, the pay rates for providers.
Right now, we get so many mental health providers going to practice, and doing self-pay mechanisms instead of staying with health plans, probably because they can get higher rates just from self-pay, and get enough people to have a good business; versus getting paid well enough to stay inside of a health plan, which is really important because that improves access to care.
Mental health parity can help with that a lot, and can help with getting better access to more types of providers, and more facilities of care for the higher levels of care. It’s super critical to then show ROI, because if people are moving into out-of-network care because of parity issues, then that really impacts all the ways that you calculate health spend. So it creates barriers to showing value when there’s not enough access to care to start with.
Hollowell: Is there any one policy either legislatively, or just within the industry in some capacity that would help improve ROI in mental health, and proving the case for it, and making it more cohesive with the larger ROI across healthcare?
Brown: I think the biggest thing we often see with people staying in care is the financial barriers to even getting started or then to stay engaged. We were happy to see that in the last large bill that they made the virtual care exception permanent for high-deductible health plans, which gives people access to care without having to burn through a very large deductible.
I think those were big barriers. We actually saw it in some of our clients that had $0 cost share for their high-deductible health plans, and then that went away in early 2025, and it’s still there notionally today, but it’s going to get better as they go forward.
Financial barriers are huge, so things that we can do to really get people engaged in mental health care from a financial standpoint, and how we’re trying to facilitate that beyond that, is going to be really important.
Trying to make it easier for plans to have maybe a $0 cost share, or preferred provider programs, and make it easier to execute those when you know you have high-quality care somewhere. Trying to find ways to reduce that deductible barrier for people, because there’s so much medical savings there, especially those with other chronic medical conditions, it’s actually going to pay for itself when you do it well. How we help people with those initial financial barriers to even get started is really critical.
Hollowell: Really critical. An ongoing conversation, as you’re well aware, in the mental health field is around value-based care models, and measurable outcomes, and measurable ROI really help make the case for many to get, and acquire these value-based arrangements. How does that influence ROI? What have you seen? What’s your experience been in that vein?
Brown: I think so far we’ve seen there are a lot of health plans, and even large employers that are really interested in value-based care in different ways, and trying to find high-quality care, and encourage people to engage in high-quality care.
There have been challenges. I think probably one of the biggest challenges I’ve heard about is around cost attribution. As more and more types of medical providers move toward value-based care arrangements, whether it’s certain types of programs with primary care providers, maybe other than ones with musculoskeletal companies, or other chronic condition companies, I think the health plans are like, “Okay, how do I parse out which value-based care arrangement actually created the actual value?”
I think that’s just really very hard to do. People are noodling their way and trying to figure out how to split that out, and then who should get a share of those value-based care arrangements. That’s super hard to figure out on the mental health side.
I think we try to take our baby steps with different employers, and health plans, and say let’s pay for performance, let’s look at total cost of care episodes, let’s look at other types of arrangements, and figure out where each plan is on, and which steps are they able to take now versus what you can grow into over time.
Those types of arrangements that help with that initial cost engagement by a member are going to be critically important. Trying to build value-based care arrangements where, on the member side, they’re incentivizing members to engage in care for the right type of care. Then on our side, trying to make sure everyone’s incentives are aligned the right way.
Whether it’s looking at quality care items that actually move the needle, I think is really important to think about. There are some that are more programmatic and structural versus those that are about, “Did they get to a certain outcome?”
We’ve seen that in national health science data. If you look at the National Health Service out of England, all their outcomes that they tracked were most influenced by structural and programmatic things versus what an individual therapist did in the session. It’s how fast to care? Could they keep them engaged in care? How many no-shows were there? Those type of things. I’d be encouraging a lot of people to think about value-based care from those types of parameters also.
Hollowell: I’ve spoken to many in the industry since I’ve been a reporter here who have said, “I’ve been in the industry for X amount of years ,and the value-based care conversation seems to have not moved that much forward.”
Since you’ve entered Behavioral Health, how have you seen conversations, and action around value-based care, and mental health ROI change from then to now, most?
Brown: I think we were fortunate because we started in the employer space, and so as we grew that part of the business, employers are a big buyer of health care. They can do very large things, and they have their incentives to contain health care costs, especially some of the larger, when you get into jumbo employers
I think we’ve seen even the last few years during COVID, it was really about, “Hey, I need to get access to care to my employees, and their families. I want a really good experience.”
Yes, we want high-quality care, but we really want them to get access to care was really the focus. I think post-COVID, there’s been more and more focus, especially the last two or three years, among a lot of employers on, “Okay, what’s the ROI am I getting? Is it really worth it? Show me that it’s worth it.”
I think there’s quite a bit of movement on the employer side in the recent few years. On the health plan side, I think there’s a lot of interest. I think they’re really trying to figure out how to do it. Those health plans, they’re very complex because there are so many different lines of business. Then trying to figure it out for commercial, and ACA, and ASO business, let alone Medicare and Medicaid, and then figure out how do I do it for each one of these lines of business? It gets really complex, really quickly.
I think they’re still trying to figure out, does it work for us? They’re trying to figure out. I think if people are getting fast access to care, but it’s a lot of care, then it’s harder to show that value. If you can get fast access to high-quality care, that’s the right amount at the right time, and then get that person to launch, and have a trial in life, come back later if they need support, it’s a different care model that we haven’t seen at scale very much. It’s always been access and good luck. Sometimes people consume a lot of care, and that hurts the whole value story in a lot of ways, even within our own industry that we have to reckon with.
Hollowell: What will it take to get there, and how do you hope things change going forward?
Brown: I think for us, it’s having more and more in our industry really show the value. First, it’s clinical outcomes. One reason I’ve been a huge proponent of measurement-based care is if we as an industry want to get paid better, we have to show our value.
If it’s on outcomes, then it is a return on investment. That’s where I focused a lot of our time, to show that. I really believe people who do high-quality mental health care work impact those individuals tremendously, and impact the rest of their medical care.
I think it’s getting pretty clear and obvious to us from our data. For example, we have two and three-year data now on health spend, where even those we took care of in year one, they continue to have incremental value in years two and three. We’re starting to show that out with some of our large employer clients. The value is there. Now it’s about trying to get a volume of it to bring to the payers of care, and to see how we can really impact how to get more people to access that care because it does bring such value, and return on investment. Then how can we help the industry be viable by sharing in those savings?
Hollowell: An ongoing conversation that we’ll absolutely continue to have.
Brown: For sure.
Hollowell: Absolutely. Thank you so much for joining me today, Dr. Mill Brown. It’s been such a pleasure to have you and Spring Health. Thank you to our audience for joining BHB Talks. We hope to see you next time. Take care.
Companies featured in this article:
