Health plans today are under pressure to deliver on behavioral health parity, not just in theory, but in practice. Yet ask any payer executive what area causes the most administrative friction, and behavioral health will almost certainly top the list. From opaque admission justifications to inconsistent treatment documentation, psychiatric care continues to be an operational outlier.
That mismatch between need and efficiency is becoming a crisis. Behavioral health units are closing at an alarming rate, not because demand is down but because operating them has become too difficult. At the same time, health plans face escalating costs and rising complaints from members who struggle to access timely, high-quality mental health care.
It's easy to assume this friction stems from stigma or lack of will. But the truth is more structural. Behavioral health lacks the operational scaffolding that underpins other areas of medicine, namely, standardized ways to measure patient acuity and track outcomes. Without that foundation, it's nearly impossible to make the behavioral health ecosystem function smoothly for payers, providers, or patients.
Why Behavioral Health Lags Behind
In cardiology, oncology, and orthopedics, providers can point to lab results, imaging, or a consistent scale to justify their clinical decisions. A patient with a certain ejection fraction or lesion size will almost universally qualify for a given procedure or medication. This data-driven standardization enables payers to make faster, more consistent determinations about coverage and necessity.
Psychiatry, by contrast, operates in a far more subjective realm. Clinicians rely on clinical judgment, observations, and interviews to determine whether a patient meets criteria for inpatient care or continuing treatment. But without shared acuity benchmarks or universally accepted scoring tools, the same patient might receive very different assessments depending on who's evaluating them.
This subjectivity creates a perfect storm for prior authorization disputes. Payers aren't necessarily denying care out of bias. They simply don't have the tools they need to confidently approve it. A recent study from the U.S. Government Accountability Office found that commercial insurers are more likely to deny inpatient behavioral health stays than comparable medical ones, in large part due to documentation gaps and ambiguity around clinical justification.
The Cost of Operational Friction
This ambiguity ripples downstream in expensive and disruptive ways. First, it drives up administrative costs for both payers and providers, as clinical teams go back and forth submitting new notes, clarifying documentation, or appealing denials.
Second, it damages member experience. Patients and families often don't understand why behavioral health claims take longer to process, or why care is harder to access, and end up frustrated with both the insurer and the healthcare system as a whole.
Third, the lack of standardized data undermines care quality. Without consistent acuity scoring and outcome tracking, providers can't easily benchmark performance or spot systemic issues. Payers, in turn, struggle to evaluate network adequacy or support high-performing facilities. This makes it harder to intervene early in cases of treatment-resistant conditions or to prevent readmissions, which are key drivers of both cost and patient harm.
Over time, these inefficiencies erode the financial viability of inpatient psychiatric care. Hospitals and behavioral health units, especially those operating on thin margins, face pressure to cut beds or shut down altogether. This shrinking of the network only compounds access problems for patients and headaches for payers trying to maintain parity compliance.
A Better Way Forward
The good news is that this isn't uncharted territory. Other areas of medicine have faced similar challenges and found ways to overcome them. Oncology, for example, is historically a highly variable field and has benefited greatly from the development of staging protocols, molecular diagnostics, and treatment pathways that tie directly to insurance approval criteria. Orthopedics, once plagued by inconsistent documentation, now uses tools like the Oxford Hip Score or WOMAC index to evaluate treatment needs and outcomes. These frameworks didn't emerge overnight, but they've transformed how care is delivered and reimbursed.
Behavioral health can follow suit. By adopting standardized acuity measurement tools and tracking progress using evidence-based outcome scales, psychiatric facilities can provide payers with the clarity they need to authorize care more efficiently and predictably. This doesn't mean reducing complex human conditions to a single number, but rather creating operational language that clinicians and insurers share.
I've seen firsthand how applying structured measurement and documentation practices can dramatically reduce friction in behavioral health claims. Facilities that track acuity and outcomes consistently are not only more likely to secure authorization quickly, but also more likely to see improvements in patient engagement, length of stay, and readmission rates. Payers benefit, too, with lower administrative costs, fewer appeals, and better visibility into network performance.
Toward a More Sustainable System
Fixing the operational gap in behavioral health isn't just about reducing claim denials. It's about making the system sustainable for everyone involved. Standardized measurement can help preserve inpatient units, strengthen networks, and ensure patients receive care at the right intensity, in the right setting, at the right time.
We're at an inflection point. Behavioral health is finally being recognized as central to overall health. But unless we modernize the operational infrastructure that supports it, we risk repeating the mistakes of the past, underfunding care, alienating patients, and burning out providers.
It's time to bring behavioral health up to operational parity. Not just because it's the fair thing to do, but because it's the smart thing to do, for payers, providers, and the millions of people who depend on this care.
