Most behavioral health policy arguments still run on stories. A person who was in and out of the hospital for years, then found a community program, got stable, went back to work. The stories are true and they matter. But a recovery story does not hold up well in a budget hearing or a payer negotiation, because the next question is always the same: how many people, and at what cost? When we can’t answer that, the work that community organizations have carried for decades gets treated as a nice-to-have instead of infrastructure.
Value-based payment is changing what counts as a good answer. Under fee-for-service, a provider got paid for the visit and nobody asked what happened after. Value-based arrangements tie payment to outcomes and to the total cost of care for a defined population (Mehta et al., 2024). That shift is hard, and behavioral health has been slow to make it — provider participation in value-based models remains low compared with the rest of health care, mostly because of structural and data barriers, not unwillingness (Center for Health Care Strategies, 2021). But the shift also hands the field something it never had: a reason for everyone in the system to care about population-level results, and to pay for the data that proves them.
This is where behavioral health Independent Practice Associations sit, and it is a useful seat. A BH IPA aggregates clinical and operational data across a network of community-based providers. At Cogency, that network is 22 partner agencies across the five boroughs of New York City. Individually, a small agency rarely has the staff or the systems to turn its records into evidence a payer will accept. Together, through a shared data layer, those same agencies can describe what they do at the scale of a population — and that description is what advocacy under value-based payment actually requires.
What the Data Has to Show
Four kinds of data do most of the work, and none of it is exotic.
Engagement comes first. Did people who were referred actually connect to care, and did they stay? Retention and follow-up after a hospital discharge are among the clearest signals that a community system is doing its job, and they are exactly what New York’s value-based readiness work has prioritized for high-risk individuals leaving inpatient settings (New York State Office of Mental Health, n.d.).
Recovery indicators come next. Measurement-based care — collecting a standardized symptom measure like the PHQ-9 at intervals and acting on the result — is how a clinical claim becomes a number you can track over time (American Psychiatric Association, 2023). The behavioral health field has been uneven in adopting it, partly because the reporting infrastructure to support these measures has never been adequately funded (Office of the Assistant Secretary for Planning and Evaluation, 2018). That gap is real, and pretending otherwise helps no one.
Total cost of care is the third. The relationship between good behavioral health care and lower overall spending is well established; integrated, evidence-based behavioral health can improve outcomes and reduce total cost (National Committee for Quality Assurance, 2021). One value-based behavioral health program reported reductions in avoidable hospitalizations and emergency department visits for Medicaid patients after expanding evidence-based practices (Mehta et al., 2024). The point for advocacy is simple: community behavioral health does not just help people, it absorbs cost that would otherwise land in emergency rooms and inpatient units. That is an argument a payer understands, but only if you have the numbers.
Equity is the fourth, and it is the one the field most often asserts without measuring. Community providers serve the populations Medicaid was built for — low-income, disproportionately affected by behavioral health disparities, and historically least likely to show up in clean data (National Academy for State Health Policy, 2025). Stratifying outcomes by race, ethnicity, disability, and other characteristics turns “we serve everyone” into a claim you can verify and, where the data shows a gap, act on. Federal and state policy is moving toward making that stratification standard rather than optional (National Academy for State Health Policy, 2025). Networks that can already produce it will be ahead of the requirement instead of scrambling to meet it.
The Infrastructure Is the Policy Ask
Here is the part that often gets skipped. None of this data assembles itself. Community agencies run on thin margins and a patchwork of electronic systems that were never designed to talk to each other. The interoperability and reporting gaps are not a failure of effort; they are a failure of investment (Office of the Assistant Secretary for Planning and Evaluation, 2018). New York recognized this when it directed enhanced federal funding toward shared data, analytics, and quality infrastructure for behavioral health collaboratives and IPAs (New York State Office of Mental Health, n.d.). That is the right instinct, and it points to where advocacy should focus.
So the advocacy case is not “fund behavioral health” in the abstract. It is more specific and more durable: fund the data infrastructure that lets community providers prove their value, then hold them to it. That framing is harder to dismiss because it asks for accountability, not just dollars.
For providers, the work is to adopt measurement-based care and report consistently, even when it adds to an already heavy administrative load — and to push for the support that makes it feasible. For IPAs and collaboratives, it is to build the shared layer that turns 22 agencies’ records into one credible dataset, and to handle the reporting burden the individual agencies cannot. For payers and policymakers, it is to pay for that infrastructure deliberately, to standardize the measures that matter, and to require stratified reporting so equity is tracked rather than assumed.
Community organizations have always done this work. What value-based payment offers — if the field builds the data infrastructure to use it — is the chance to stop asking to be believed and start being able to show it. That is a stronger position than any single story, and it is one the behavioral health community is finally close enough to reach.
Mohsin Sardar, PhD, is Director of Clinical Data Analytics at Cogency Integrated Healthcare IPA, LLC, a New York State–certified behavioral health IPA serving all five boroughs of New York City. He also leads development of TherAssist, an AI therapy assist model at the Global Center for AI in Mental Health, and is an adjunct professor at SUNY Westchester Community College, where he teaches U.S. Healthcare Systems.
References
American Psychiatric Association. (2023). Resource document on implementation of measurement-based care. https://www.psychiatry.org/getattachment/3d9484a0-4b8e-4234-bd0d-c35843541fce/Resource-Document-on-Implementation-of-Measurement-Based-Care.pdf
Center for Health Care Strategies. (2021). Behavioral health provider participation in Medicaid value-based payment models: An environmental scan and policy considerations. https://www.chcs.org/media/behavioral-health-provider-participation-in-medicaid-value-based-payment-models-an-environmental-scan-and-policy-considerations.pdf
Mehta, R., Dayan-Rosenman, D., Sellinger, D., & Tang, M. H. (2024). Improving treatment and lowering costs for behavioral health patients through a value-based care program. NEJM Catalyst, 5(12). https://catalyst.nejm.org/doi/full/10.1056/CAT.24.0082
National Academy for State Health Policy. (2025). Data strategies to understand and address health disparities. https://nashp.org/data-strategies-to-understand-and-address-health-disparities/
National Committee for Quality Assurance. (2021). Behavioral health quality framework: A roadmap for using measurement to promote joint accountability and whole-person care. https://wpcdn.ncqa.org/www-prod/wp-content/uploads/2021/07/20210701BehavioralHealthQualityFrameworkNCQAWhite_Paper.pdf
New York State Office of Mental Health. (n.d.). Behavioral health value-based payment readiness program. https://omh.ny.gov/omhweb/bho/bh-vbp.html
Office of the Assistant Secretary for Planning and Evaluation. (2018). Development and testing of behavioral health quality measures for health plans: Final report. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/development-testing-behavioral-health-quality-measures-health-plans-final-report-0
