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/

Connect with The Mental Health Evolution

• Website: mentalhealthevolution.com

• Instagram: @mentalhealthevolution

• LinkedIn: Mental Health Evolution

• Facebook: Mental Health Evolution

Music credit: Music by Zach Harrison

Episode Description
In this solo episode, Rachel reviews the major mental health stories and trends she anticipates will shape 2026. Covering topics from the growing behavioral health market to hybrid human-AI care, policy developments, digital platform growth, affordability pressures, point-solution fatigue, and global workforce gaps, this episode provides a comprehensive overview of what to watch in the year ahead. Listeners will gain context on opportunities, risks, and emerging challenges in the mental health field.

Key Topics Discussed

• Expanding behavioral health market: growth, opportunities, and challenges for clinicians and practices

• Human-AI hybrid models: integrating technology without losing the human touch

• AI in government and public health: potential improvements and privacy concerns

• Scaling digital mental health platforms and evolving business models

• Affordability and insurance pressures impacting patients and practices

• Point-solution fatigue in AI tools and the need for better integration

• Global mental health demand, workforce shortages, and gaps in care delivery

Main Takeaways

• Rapid market growth brings both opportunity for innovation and risk for small practices

• Hybrid care models can improve access and efficiency but must preserve human connection

• Government adoption of AI requires careful attention to privacy, security, and equity

• Digital platforms are transforming patient access, but competition and consolidation create challenges

• Mental health workforce gaps remain global; strategic planning is needed to meet demand

Notable Quotes

• "Even if you choose not to use AI tools in your practice, AI is likely coming for you anyway."

• "The human-AI blend offers the best of both worlds: accessibility from technology and empathy from humans."

• "Point-solution fatigue is slowing adoption and creating skepticism about whether AI is truly helping."

Resources Mentioned

• Behavioral Health Market to Reach USD 172.61 Billion by 2034

• AI and Mental Health Care Tools: Dangers and Risks

• HHS Announces AI Strategy for Health and Human Services Operations

• US employee health insurance premiums to rise 6% next year, Mercer says

• Over a Billion People Living with Mental Health Conditions – Services Require Urgent Scale-Up

Connect with The Mental Health Evolution

• Website: mentalhealthevolution.com

• Instagram: @mentalhealthevolution

• LinkedIn: Mental Health Evolution

• Facebook: Mental Health Evolution

• Music Credit: Music by Zach Harrison

Episode Description:
In this episode, Rachel sits down with Dr. Scott Feers, Chief Medical Officer at Amae Health and a leading psychiatrist and neuroscientist, to explore the evolving landscape of severe mental illness (SMI) care. They discuss the innovative integration of technology, AI, and wearable devices into clinical practice to improve outcomes and prevent hospitalizations for individuals living with SMI.

Dr. Feers shares insights from his decades of research and clinical experience, highlighting how Amae Health combines conventional in-person care with digital tools for monitoring, early intervention, and precision treatment. Listeners will gain a clear understanding of how mental health care is being transformed to focus on both mental and physical health, emphasizing the importance of human connection alongside technology.

Key Topics Discussed:

• Challenges of traditional SMI care and repeated hospitalizations

• The role of AI in supporting clinicians without replacing human interaction

• Wearable devices and data-driven insights for sleep, activity, and heart health

• Early detection of relapse to prevent full decompensation

• Integration of primary care, nutrition, and movement into mental health treatment

• Translating neuroscience and genetics research into real-world clinical applications

• Cost efficiencies through early intervention and improved treatment tracking

Main Takeaways:

• Technology and AI can augment care, but human connection remains central to mental health treatment.

• Wearables and digital phenotyping provide objective insights that enhance clinical decision-making.

• Early intervention can prevent hospitalizations, reducing human suffering and healthcare costs.

• Addressing physical health is essential for improving overall outcomes for people with SMI.

• Integrating research-based tools into routine care makes treatment more precise and effective.

Notable Quotes:

• "I have a very strong belief that humans and connections to humans is the core of mental health treatment."

• "If we can catch relapse early, see if we can do low risk, simpler intervention to prevent the more complicated treatment interventions."

• "We know that folks with serious mental illness often have reduced lifespans… a lot of the causes of mortality are basic things like cardiovascular health."

Resources Mentioned:

• For-profit companies open psychiatric hospitals in areas clamoring for care — CBS News

• Private Equity Among US Psychiatric Hospitals — JAMA Psychiatry

• Amae Health Announces $25 Million Series B — Business Wire

Connect with Dr. Scott Feers:

• Website: https://www.amaehealth.com/team/scott-fears

Connect with The Mental Health Evolution:

• Website: https://www.mentalhealthevolution.com

• Instagram: @mentalhealthevolution

• LinkedIn: Mental Health Evolution

• Facebook: Mental Health Evolution

Music Credit: Music by Zach Harrison

Episode Description:
In this second part of her conversation with Josephine Wilton, Chief Strategy Officer at Hullanta Consulting, Rachel dives deeper into the complexities of value-based care. Josephine draws on decades of experience in managed care strategy, population health, and contract design to explore why these models often feel difficult to implement.

This episode examines the operational realities behind value-based care, including the importance of utilization data, the impact of contracts on organizational performance, and the necessity of interdisciplinary collaboration. Listeners will gain actionable insights on how to navigate these challenges, advocate for their teams, and optimize care delivery in a system that is constantly evolving.

Key Topics Discussed:

• Understanding the impact of value-based payment measures on provider organizations

• Why utilization data is critical for telling your organization's story

• Contract design and its influence on revenue, operations, and organizational outcomes

• Engaging specialists and ancillary providers in value-based care

• The role of social determinants of health in patient outcomes and reimbursement

• Strategies for data-driven decision-making and negotiating with health plans

Main Takeaways:

• Ownership of your data is essential — know your utilization metrics and communicate your story clearly

• Value-based care cannot succeed with primary care alone; specialists and ancillary providers must be included

• Contracts influence all parts of an organization, not just payment; thorough review is critical

• Collaboration across disciplines and sharing actionable data drives better outcomes

• Advocating for your organization requires persistence and strategic negotiation with health plans

Notable Quotes:

• "So it's very incumbent upon you to tell your story in your way. Don't let someone else tell your story." — Josephine Wilton

• "Primary care cannot do it alone. You need cardiology, endocrinology, podiatry, everyone involved, and they typically haven't so they're contributing to the total cost. They're seeing different needs of the patients than the other providers." — Josephine Wilton

Resources Mentioned:

• National Committee for Quality Assurance (NCQA)

• Centers for Medicare & Medicaid Services (CMS)

• National Academy for State Health Policy

• Milliman

Connect with the Guest:
Josephine Wilton, MHA
Chief Strategy Officer, Hullanta Consulting
hullantaconsulting.com

Connect with The Mental Health Evolution:

• Website: mentalhealthevolution.com

• Instagram: @mentalhealthevolution

• LinkedIn: Mental Health Evolution Podcast

• Facebook: Mental Health Evolution Podcast

Music Credit: Music by Zach Harrison

Episode Description:
In this episode, Rachel sits down with Josephine Wilton, Principal Consultant at Hullanta Consulting, to dive deep into the operational realities of implementing value-based care. They discuss the challenges organizations face in aligning data, staff, and financial models, and how smaller practices and solo practitioners navigate these complex systems. Josephine shares actionable strategies for bridging the gap between theoretical value-based models and real-world execution.

Rachel and Josephine had so much to cover that they'll be back next week to continue the conversation, exploring even more practical solutions and lessons learned from both providers and payers.

Timestamped Highlights:

1. 0:52–4:28 – Introduction of Josephine Wilton and her expertise in operationalizing value-based care.

2. 5:04–7:40 – Early contracting stages and the importance of communication between providers and payers.

3. 10:15–12:27 – Why operational and clinical teams must be involved early in negotiations.

4. 13:30–16:23 – Challenges faced by solo practitioners and smaller organizations in value-based care.

5. 18:32–21:36 – Importance of real-time data and the delays that can impact value-based programs.

6. 26:25–28:24 – Friction points in attribution, performance metrics, and total cost of care.

Key Topics Discussed:

• Value-based care models vs. fee-for-service systems

• Operational and clinical alignment during contract negotiation

• The critical role of real-time data in decision-making

• Challenges for small and solo practices

• Understanding total cost of care and outcomes measurement

Main Takeaways:

• Early involvement of clinical and operations teams is crucial to success.

• Real-time data access is necessary to track performance and guide decisions.

• Smaller organizations may have agility but require support with modeling and analytics.

• Clear communication between providers and payers prevents misalignment and frustration.

• Understanding both baseline and value-based payment structures is essential before execution.

Resources Mentioned:

• Implementing Value-Based Care, a Scoping Review

• Value-Based State-Directed Payments in Medicaid, Feb 2023–May 2024

• Why Primary Care Practitioners Aren't Joining Value-Based Care Payment Models

Connect with the Guest:

• Josephine Wilton, Hullanta Consulting

Connect with The Mental Health Evolution:

• Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast

• Instagram: @mentalhealthevolution

• LinkedIn: Mental Health Evolution

• Facebook: Mental Health Evolution

Music by Zach Harrison

• 00:03 – Introduction to Matthew Stone and overview of episode
• 06:10 – Discussion on the increase in student mental health needs post-COVID
• 11:03 – Overview of federal grant shifts and funding uncertainty
• 14:07 – Impact of grant terminations on hiring and staffing
• 19:01 – Focus on school psychologists and narrowing of grants
• 25:38 – Implications for districts trying to fulfill local needs

• COVID's impact on student mental health
• Federal grant programs for school mental health
• Policy changes and administrative priorities
• Workforce challenges: counselors, social workers, and psychologists
• Local district strategies for sustaining services

• Student mental health needs have increased, exacerbated by COVID
• Policy changes and grant terminations create uncertainty for districts
• Narrowing grants to school psychologists may limit local flexibility
• States and districts are developing innovative strategies to meet needs
• Sustaining mental health services requires planning beyond federal funding

• "I think the focus on school psychologists has stumped a lot of people in the mental health world."
• "Schools are navigating unprecedented changes while trying to provide consistent support to students."

• KFF: The Landscape of School-Based Mental Health Services
• US House Press Release: Fitzpatrick Leads Bipartisan Coalition
• Education Week: Trump Admin Relaunches School Mental Health Grants