Bigger Platforms, Same Bottlenecks: Why Consolidation Isn’t Expanding In-Network Care
Behavioral Health Business
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By Laura Lovett | October 8, 2026
Image by Rosy / Bad Homburg / Germany from Pixabay
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This is an exclusive BHB+ article.
I’ve sat through enough investor presentations to know the pitch: the mental health market is ripe for consolidation. The business logic is easy to follow. The industry is fragmented, with many small, independent providers. But the promise of expanded access deserves more scrutiny. A larger platform isn’t necessarily more accessible, and corporate growth and patient access measure success differently.
Many of these acquisitions, and even de novo expansions, have been in the direct-to-consumer outpatient market. The growth of these platforms can often signal greater patient access. And while most outpatient providers — including Thriveworks, Talkspace and Octave — work with commercial payers, new data tell a different story.
A recent report from Trilliant found that while most online providers accept insurance, a whopping 34% of psychologists do not, meaning that access to behavioral health services remains a major challenge. To put that in context, that is up from 18.2% in 2021. And it’s not just psychologists; patients are also more likely to see an out-of-network psychiatrist than other types of doctors by a wide margin.**
“It tells us the in-network option often isn’t there when patients need it,” Allison Oakes, chief research officer at Trilliant, told me in an email. “Patients are 8.9x more likely to see a psychiatrist out of network than a medical or surgical physician, and the supply problem is only expected to get worse.”
In this exclusive BHB+ Update, I will explore:
- Why so many therapists and psychiatrists still prefer out-of-network patients
- Where therapist enablement platforms could be missing the mark
- Value-based care’s role in fixing this problem