Are we solving the wrong problem in behavioral health care?
In a recent Behavioral Health Business piece titled “Beyond the Worried Well,” the author discusses how payors have significantly expanded access to direct-to-consumer online therapy tools like Headway, Talkspace, and other low-cost virtual therapies. They cite improved access to mental healthcare, primarily for lower-acuity patients; outpatient behavioral health visits increased 62.6% between 2018 and 2024, and behavioral health now accounts for about two-thirds of all telehealth utilization.
However, while acknowledging that managing serious mental illness delivers the most meaningful savings per patient, the author argues that payers should rein in aggregate spending by serving more lower-acuity members, using these cost-effective solutions.
The data doesn’t agree. When we break down the cost curve, it’s clear that behavioral health spending isn’t evenly distributed. The highest-risk quartile of mental health patients (25%) accounts for the vast majority of total mental health medical expenses (>90%), with emergency rooms and inpatient care driving about half of that spend.
If our primary goal is to improve access for lower-acuity patients, these solutions will provide an increasingly reliable, relatively inexpensive, and scalable answer. But are we solving the right problem? In a world of scarce mental health resources and funding, investing further in the lower-acuity population isn’t the most economical or urgent use of our resources.
According to Trilliant Health’s 2026 Behavioral Health report, despite growth in outpatient mental health services, inpatient utilization continues to grow consistently, seemingly unaffected by improved outpatient access. It appears we’re building an outpatient mental health system that isn’t reaching, nor is it designed for, the patients who are most at risk of being admitted to the hospital.
Why do these low-acuity outpatient services keep expanding? The answer lies in:
- Regulatory support
- Payer perception of cost/value
- Providers’ need to gravitate towards available funding
In healthcare, innovation moves at the speed of regulation. Outpatient mental health services have benefited from regulatory support recently, and the expansion of telemedicine has fueled telepsychiatry practices. Parity law has bolstered network adequacy. New therapies and technologies have been approved, expanding access to treatment.
From a service-cost standpoint, new outpatient solutions look attractive. However, low-acuity and subclinical interventions historically accounted for very little of total spend. Cash-pay online therapy subscriptions cost $250-400 a month, while negotiated commercial rates for individual psychotherapy are $150 per session—a drop in the bucket compared to a single day of inpatient psychiatric treatment, which averages $1,179 per day. Across a full admission, the gap increases: the average commercially insured inpatient stay for a mental health event cost $15,900 in 2023, according to the Peterson-KFF Health System Tracker.
Weighing the small, incremental expense of these outpatient services against the much greater expense of inpatient care doesn’t hold up, because low-acuity patients are the least likely to require inpatient care. Low-cost outpatient care is not a replacement for high-cost inpatient care if it’s directed to low-risk populations.