Integrated Care & Health Plan Strategy: Why Behavioral Health Providers Must Adapt

By CSBMG | June 9, 2025

Recent data on national health plan enrollment trends reveals critical insights for behavioral health providers like the Community Service Board of Middle Georgia (CSBMG). Between 2020 and 2024, the U.S. health insurance market experienced notable shifts, with both Blue Cross Blue Shield (BCBS) and non-BCBS plans growing by approximately 7%, adding over 12 million members (Oss, 2025). These shifts are not just numerical—they represent evolving consumer needs and signal increased demand for providers who can demonstrate integrated, cost-effective care delivery.

From 2020 to 2024, non-BCBS plans saw their enrollment grow from 122.5 million to 131.4 million, while BCBS plans increased their coverage from 51.7 million to 55.2 million members (Oss, 2025). Medicare Advantage (MA) plans, in particular, saw a surge in enrollment, rising by over 8 million members across both BCBS and non-BCBS plans. However, Medicaid enrollment dropped by 14.2 million following the end of the public health emergency—underscoring how policy shifts can rapidly affect access to care.

The relevance for CSBMG and agencies like ours is clear: individuals with behavioral health conditions, especially those diagnosed with serious mental illness (SMI), represent a disproportionately high cost to health plans. Medicaid beneficiaries with a mental illness incur roughly twice the healthcare costs—around $14,000 annually—compared to their peers without mental illness. For those with SMI, the average cost rises to $21,000 per year (Oss, 2025). These figures are driven largely by the high rate of comorbid chronic conditions, such as substance use disorders (SUD), which affect 40% of individuals with SMI.

As approximately 79% of individuals with SMI are enrolled in managed care plans—including commercial, Medicare, and Medicaid models—health plans are increasingly seeking behavioral health providers capable of managing both mental and physical health conditions (Oss, 2025). At CSBMG, we recognize the need to demonstrate our value through whole person care, collaborative outcomes, and cost-effective service models. To this end, one of our current projects is working toward certification as a Certified Community Behavioral Health Center (CCBHC) through Substance Abuse and Mental Health Services Administration (SAMHSA) and Department of Behavioral Health and Developmental Disabilities (DBHDD).

To succeed in this landscape, provider organizations must develop comprehensive health plan strategies. Such as aligning services with payer metrics (such as HEDIS and Medicare Star Ratings), and offering pilot programs with shared savings or gainsharing incentives (Oss, 2025). These steps foster long-term partnerships and open pathways to new funding models.

Additionally, adapting to new payment models will require investment in workforce capacity, technology infrastructure, and data analytics. As Andrea Mander, Executive Vice President at OPEN MINDS, points out, both payers and providers must evolve, including advocating for adequate reimbursement, while ensuring integrated care delivery models are evidence-based and financially sustainable (Oss, 2025).

Health plan relationships are no longer just contractual—they are strategic. At CSBMG, we are committed to optimizing these partnerships to better serve our clients and ensure long-term organizational resilience. As healthcare moves further toward integration, our leadership continues to seek new opportunities to align services with payer priorities and improve outcomes for individuals across Middle Georgia.

References

Oss, M. E. (2025, June 5). And the beat goes on… OPEN MINDS. https://www.openminds.com