This is an exclusive BHB+ article
At this time of year, it seems every town or city has its own ‘Jingle Jangle’ — my sister’s name for those festive evening strolls where they light the Christmas tree or menorah. In my seaside town, ours is a tree made entirely out of lobster traps.
And inevitably, there’s always a letterbox where children can send letters to Santa with their wish list. Though my 15-month-old daughter successfully got a family to surrender their balloons to her at an Armenian restaurant last week by pointing and emphatically yelling “more,” we’re not quite there yet with verbalizing a wish list.
So instead, I’ll write out my wish list this year. But instead of toy trains and drums, I’m giving you my behavioral health wish list. I’m curious how much sway big old Santa Claus has with payers, but if he does have an in, this list is for him.
In this BHB+ Update, I will explore:
– Why standardized measures for behavioral health outcomes could be closer than we think
– How new reimbursement pathways could open up more opportunities for pediatric mental health care
– Why the future of AI needs guardrails in behavioral health
1. Standardizing measurement-based care outcomes
I chose this one, in part, because I could see a glimmer of hope that this would come true in the new year. For decades, the behavioral health industry has been talking about value-based care and, in turn, outcome measures.
But one of the main issues has always been the lack of standardization across providers and payers, which has fragmented the move to value-based care contracting. Today, every contract is unique, and the measures are specific to it. The amount of work that goes into creating these contracts can often mean payers only want to partner with providers with scale.
Without industry standards, proving quality can be difficult.
However, things may be changing. Earlier this week, the Association for Behavioral Health and Wellness (ABHW), an industry association representing the bulk of major health plans, announced a set of measurement-based care metrics. The set of measures includes a variety of metrics, including symptom improvement, functioning and stability, recovery and relapse prevention and effectiveness of evidence-based care.
The measures are also looking at access metrics such as follow-up after an emergency department visit for mental health or SUD incident, antidepressant medication management and adherence to antipsychotic medications for people with schizophrenia.
I think it’s a great step in the right direction, and the measures coming from a payer organization could hold real clout in the industry.
Operators have previously warned that if provider groups don’t unite around a set of outcome measures that drive value, payers will drive the conversation. And it seems that, in some ways, fear has come to fruition. Still, any standardization effort would likely help the industry adopt new models of care.
So I suppose my wish would be to have standardization in outcome measures with agreement from both payers and providers. And maybe next year at our VALUE conference, we can stop talking about which metrics need to be considered and start talking about how to implement them.
2. New reimbursement pathways for pediatric care
Young people in America have increasingly poor mental health outcomes. And getting individuals into care is often difficult, with long waitlists.
“I think it’s still pretty difficult for you to get access to care for a child on an in-network basis at any reasonable timeframe,” Brian Wheelan, CEO of Transformation Care Network, previously told me.
But providing care to pediatric populations isn’t always easy, and many providers treating them have struggled in the past year.
For example, Nashville, Tennessee-based pediatric and young adult behavioral health care provider Newport Health laid off staff and closed nine locations earlier this year. And virtual pediatric behavioral health provider Brightline shut down operations in 45 states in 2024 to focus on a more hybrid model of care in five states.
One of the hardest parts of offering mental health services for children and young people is the reimbursement model. Typically, services are still offered on a fee-for-service basis, where the provider gets paid for the time spent with the client.
While this model is standard for adult populations, it can be challenging in pediatric care, which generally takes a multidisciplinary approach. Providers often need to engage with parents, schools and even government agencies. This can equate to many additional nonbillable hours.
On my wish list, I would like a way to help providers get paid for these hours, whether it be a value-based care arrangement, a better reimbursement path for family education and coordination, or higher rates for pediatric services than adult services, given all of these additional parameters.
3. Clear, defined guardrails around AI in mental health and substance use disorder treatment
The promise of AI in behavioral health is both very exciting and very scary. It’s no wonder that mental health has featured on several episodes of Black Mirror.
Today, the most popular use case for AI in behavioral health is back-office tasks. Still, conversations about AI as a substitute for traditional therapy have taken flight.
While many large AI companies have said the technology isn’t intended for therapy, that doesn’t necessarily stop folks from using it that way. Recent research has demonstrated that 49% of people with a self-reported mental health condition who use large language models LLMs, such as ChatGPT, are using the technology for mental health support.
There have been some efforts to implement guardrails. For example, OpenAI, maker of ChatGPT, has begun to build a network of licensed mental health professionals that its users can access directly through the chat platform.
But it’s not just patients turning to AI; some clinicians also need to be careful about the lure of non-HIPAA-compliant AI.
“Any kind of AI assistance is going to have risk to it,” Dr. Rachel Wood, a cyberpsychology researcher and the founder of the AI Mental Health Collective, told BHB reporter Ashleigh Hollowell. “But when you are moving over to a non HIPAA-compliant platform – like ChatGPT – that trains on your data, you really don’t want to be using this in any kind of professional capacity with client or patient information.”
Still, I think that, for true AI guardrails to be effective, they will likely need to be established either through legislation or, at the very least, through professional associations that implement requirements for providers.
4. Less talk, more action on parity enforcement
Mental health parity is the law of the land. Yet for many behavioral health providers – and the patients they serve – true parity still feels more theoretical than real.
In 2026, BHB would like to see parity enforcement move from discussion to consequence.
Providers continue to report prior authorization hurdles, narrow networks, inconsistent medical necessity criteria and reimbursement rates that lag far behind physical health, even when plans claim compliance on paper. Regulators, meanwhile, have grown more vocal, issuing guidance, reports and requests for comparative analyses.
That’s progress. But it’s not enough.
What’s still missing is consistent, visible enforcement that changes payer behavior.
5. More ‘boring operators’ and fewer ‘visionaries’
Behavioral health doesn’t have a shortage of big ideas. What it often lacks is disciplined follow-through.
In 2026, BHB is wishing for more “boring” operators – the kind of leaders who obsess over scheduling accuracy, supervision ratios, documentation turnaround times and payer mix long after the vision deck has been approved.
That kind of operational excellence doesn’t make for flashy conference keynotes or breathless press releases. But it’s what keeps providers open, clinicians supported and patients consistently served.
Too often it feels, behavioral health organizations (especially those on the digital side) are led by executives chasing the next growth story while foundational issues quietly erode the care model underneath them. Vision matters. Strategy matters. But without leaders willing to live in the operational weeds, even the most compelling mission statements collapse under their own weight.
If 2026 brings anything, we hope it brings renewed appreciation for leaders who build durable systems instead of just telling inspiring stories.
