This is an exclusive BHB+ article
For years, payers and providers stood on opposite sides of the aisle — one providing care and advocating for services, the other paying for that care while demanding proof of outcomes.
But I have seen that as integrated care has grown in popularity, so too has the concept of the payer, provider — or payvider, if you will.
“To me [payvider] means marrying the two core prerogatives of our big stakeholders in healthcare,” Samir Malik, CEO of firsthand, told me. “The prerogative of providers is to deliver individual-centric maximum care, and the prerogative of the health plan is to deliver population health outcomes. These two things can be intentional when they are separate bodies, which is why we have issues around deeper service. So for me, payviders means you’re bringing both those incentives into one organization, that one organization is responsible for both thinking about the population level outcomes and also individually, the best outcome per person, served.”
firsthand is a value-based care provider that cares for individuals with serious mental illness through the use of peer support specialists to help reach its clients.
A payvider can take the form of a healthcare conglomerate like UnitedHealth Group, which both delivers care through its health services division Optum and provides health insurance through UnitedHealthcare.
Still, it can also mean a provider is now taking on population-level risk, often through a value-based care arrangement.
“Either way, you’re marrying these two core prerogatives to try to walk and chew gum at the same time,” Malik said.
Today, most major payer organizations have a health services division, and the bulk of those have some behavioral health offering. Some of those divisions have even made major acquisitions in the behavioral health space, using the increased service offerings as a lever for growth.
Despite recent regulatory pushback, we’ll see more of these payviders in the future as incentives align through value-based care and as payers continue to search for new ways to expand their offerings.
In this BHB+ Update, I will explore
–Why payers are buying up behavioral health providers
–The challenges of implementing a payvider model in behavioral health
–The future of the payvider amid regulatory scrutiny
A growing interest in payvider delivery
The payvider model has gained some traction over the past few years. Payers especially, have begun to acquire or roll out additional behavioral health services.
One of the most notable acquisitions in the space was Optum’s 2022 acquisition of outpatient mental health practice Refresh Mental Health. Refresh has since purchased CARE Counseling to cut wait times.
Additionally, Elevance Health Inc. (NYSE: ELV) purchased behavioral health provider Beacon Health Options in 2020, which it later rebranded to Carelon Behavioral Health.
Then in 2024, Cigna’s (NYSE:CI) health service division launched the Evernorth Behavioral Care Group. The service line focuses on value- and measurement-based care in behavioral health.
As behavioral health costs increasingly strain payers’ budgets, there’s a growing incentive to bring care in-house. However, many in the field say these integrated models can only succeed if the payer and provider sides of the business maintain aligned incentives and shared goals.
“There has been some growing interest in this model given what is considered a siloed nature of behavioral health, which is where we see long waitlists, a lack of cost transparency and little alignment on care outcomes,” Jenny Welling-Palmer, chief strategy officer of Thriveworks, told me.
Thriveworks is one of the largest outpatient mental health providers in the country. As of 2024, the provider had 340 facilities in 49 states and Washington, D.C., and employed over 2,200 clinicians.
“While the merger of payer and provider can certainly offer a sustainable solution, I believe the most successful models center on true collaboration between behavioral health providers and payers, such as shared data, goals and accountability, while each focusing on what they do best,” she said.
Challenges for payviders in behavioral health
While the payvider model has really begun to take off within primary care and physical health care, the behavioral health industry poses some unique challenges.
“There is a reason more payers aren’t wading into the delivery side of behavioral health,” Welling-Palmer said. “The complexities, such as high demand, changing expectations, clinician shortages and variable engagement, create huge and often not cost-effective challenges. The juice doesn’t feel worth the squeeze. It’s these reasons that make a more aligned approach so important, especially given behavioral health interventions’ outsized impact on overall health and total cost of care. The key is partnership: shared measurement frameworks, flexible benefit design, strong navigation, and coordinated data improve continuity and help individuals stay engaged in care.”
The financial benefits can also be difficult to prove on the behavioral health side of things. Malik noted that recovery cycles in behavioral health are typically longer than in physical health. It can take anywhere from two to seven years for a person to reach recovery.
“You can talk to many providers who could say, If only I can do XYZ today, we would see better outcomes, two, three years down the line, and a payvider, incentive system that rewards near term investment for long term outcomes should generate long term cost savings, but is it going to deliver in year savings that a tight market is looking for?” Malik said. “I think that’s a little bit harder.”
While we’ve seen an increase in payviders in mental health care, some areas of behavioral health are likely not ready for the model, such as autism services, which, for the most part, remain highly unregulated and fragmented.
“I don’t anticipate seeing payviders emerge [in autism services]. I also don’t think that you’ll see some of the big payers and benefit managers here acquiring into ABA,” Dan Beuerlein, managing director at Brentwood Capital Advisors, said at the 2025 Autism Investor Summit East. “I don’t think Magellan or Optum are going to start buying ABA practices, in part because of the fragmentation, just how much they would need to buy to get real network density relative to their scale. I think where you will see in evolution, and I hope you see in evolution, is towards more value-based care arrangements.”
Brentwood Capital Advisors is a health care-focused M&A advisory firm.
Beyond the operational complexities of running a payvider model, federal regulators have also begun questioning its practices.
In September, Democrats in the U.S. Senate and House of Representatives released the Patients Over Profits Act, which prohibits future payer-provider conglomerates. Lawmakers said the payvider model has allowed major companies to put profits before patients.
”As they consolidate the market around them, they are also creating a structure that denies people the ability to visit a physician of their choice,” Rep. Pramila Jayapal (D-Wash.) said in a statement. “This is absolutely unacceptable, and it allows them to jack up already absurdly high health costs, deny necessary treatments if they’re too expensive, and keep wages low for doctors, nurses, and the staff that keep hospitals running.”
Despite these challenges, I don’t see the payvider model stopping anytime soon, unless a law passes prohibiting these practices. This is in part because antitrust laws make it difficult for payers to expand through acquiring fellow insurers. For example, Aetna’s planned acquisition of Humana and Anthem’s proposed purchase of Cigna were both blocked by federal judges.
This leaves expansion through health services as a key growth lever for payers, especially. And on the provider side, as value-based and risk-based arrangements become more commonplace, there is likely a less controversial path forward for these entities.
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