In this episode, Rachel speaks with Cathy Gilbert — Founder and Principal Consultant at CEG Health — about what's happening inside today's behavioral health systems from both the payer and provider perspectives.
Earlier this year, Rachel and Cathy spoke about the Big Beautiful Bill, and that conversation opened up so many rich threads around contracting, payer relations, and system design that they kept going. They recorded a second conversation to dive deeper into those broader themes — and this episode is Part Two of that discussion.
Cathy shares how value-based care is unfolding in behavioral health, the data and measurement challenges that make it harder to implement, the impact of insurer-owned clinics, and practical strategies for patients navigating access barriers in a system already stretched by workforce shortages.
The current state of value-based care in behavioral health and why implementation is still slow
Challenges of measuring mental health outcomes and reliance on PHQ-9 and GAD-7
How eliminating prior authorization changed payer visibility into outpatient care
Small-practice dominance in behavioral health and inherent capacity limits
Operational ways technology can genuinely support small practices (online scheduling, integrated EHR tools, measurement automation)
Insurer-owned clinics in pharmacies and big-box settings: access benefits vs. workforce limitations
Workforce pipeline issues, provider retirements, and psychiatry shortages
Cultural expectations in the U.S. around speed, cost, and "the best care"
Practical strategies for patients to access care within a constrained system
Evernorth Study on Behavioral Health Value-Based Care
https://www.fiercehealthcare.com/payers/evernorth-study-look-progress-toward-value-based-care-behavioral-health
Times Union — Congressman Pat Ryan Releases Optum Health Survey Results
https://www.timesunion.com/health/article/optum-survey-results-pat-ryan-20255087.php
Cathy Gilbert
Founder & Principal Consultant — CEG Health
Website: https://ceghealth.com/
LinkedIn: https://www.linkedin.com/in/cathy-gilbert-29648421/
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Music credit: Music by Zach Harrison
