“It’s the member, not the provider or the payer, who must be at the center of value-based care.”
Katherine Wooten, LCSW, BCBA, CCM – Senior Director, Clinical Strategy & Research
Change was the topic in many conversations at Becker’s Payer Issues Roundtable Spring 2025, where payers and health system leaders gathered to exchange real-world lessons and strategies in Chicago. For those of us focused on behavioral health (BH), it’s clear that new models are needed. As we heard from several panelists, it’s going to take a combination of bold thinking, smart data and a deeper understanding of patient needs to make lasting change.
Behavioral health needs a better payment compass
Lucet’s Senior Director of Clinical Strategy and Research Katherine Wooten and fellow panelists Harlon Pickett of Eagle Care Health Solutions and Corey Leftwich of Louisiana Blue took part in a panel entitled “Developing Payment Models Aligned with Health Plan Goals.” The group discussed what it looks like when a payment model is aligned with true behavioral health outcomes rather than cost containment.
According to Wooten, “It’s the member, not the provider or the payer, who must be at the center of value-based care.” She noted that fee-for-service models don’t just fail — they actively work against long-term success in BH by favoring quantity over quality, overlooking essential services like care coordination and community supports, and failing to capture the full picture of what patients really need.
Wooten advocates for models that focus on the quality of connection: speed to care, alignment with the right provider and the ability to quickly course-correct. “By doing what’s right for the member,” she said, “the money side will take care of itself.”
Corey Leftwich described how Louisiana Blue evaluates its diverse provider network. “We used to rely heavily on clinical data to evaluate providers, but it didn’t work in rural areas that lacked access to robust EHRs,” he explained. That led them to reconsider their approach, tapping into claims and EHR data with more nuance. “Every two or three years, we have to reevaluate. There’s a law of diminishing returns. What works for one region or group may not work for another.”
Payment models: What works, what doesn’t
The panel discussed payment models that didn’t work for their networks in the past, such as peer-to-peer review. “We eliminated it,” said Pickett. “Different specialties didn’t understand each other’s work well enough to make the right evaluations.” They now rely more on claims, outcomes and evidence-based medicine, with built-in second opinion mechanisms that challenge providers in a constructive way.
Direct primary care was cited as a model that works, with Pickett highlighting how it reduces cost barriers and brings BH into the everyday patient experience. “There is no reason for you not to go see your doctor when the model includes everything,” he said. “People now have their doctor in their phone.”
Don’t let infrastructure be a barrier
Both Wooten and Leftwich voiced concern about rural and smaller providers getting left behind. “Downside risk doesn’t work for all providers,” Wooten noted. The infrastructure isn’t there yet in many areas, and payers must build flexibility into their models to ensure equity in access and care delivery.
This is especially relevant as BH continues to lag behind the broader medical field in defining what “good” looks like. It’s time to prioritize not just what’s measurable, but what’s meaningful: addressing loneliness, building trust and making space for underserved conversations — from women’s health to mental health stigma.
“If you have the data, use it to make things better,” said Pickett. “Be the change.” The panelists were united on this point: value-based behavioral health care will only succeed when it’s rooted in trust, transparency, and accountability — among payers, providers and the people we serve.
Rachel Jenkins is a marketing manager at Lucet.
