Behavioral Health CEO Report

Priorities and insights on the state of behavioral health

In Partnership With


The State of Behavioral Health in the U.S.

*Percentages in this report may not total 100 due to rounding

The current state of behavioral health in the United States is unprecedented. In 2019, prior to the pandemic, nearly 20% of American adults experienced1 a mental illness and almost 5% of adults report having serious thoughts of suicide, which has increased every year since 2011. The COVID-19 pandemic has only worsened the national behavioral health crisis. According to the Kaiser Family Foundation, about half of adults (47%) continue to report2 negative mental health impacts related to worry or stress from the pandemic. According to the Centers for Disease Control and Prevention3, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. At the same time, therapists say4 they can’t keep up with the demand for their services.
As the demand for behavioral health services is skyrocketing, access to much-needed care remains difficult for a large number of Americans. In fact, more than half of adults with mental illness do not receive5 treatment, totaling over 27 million U.S. adults. With workforce shortages caused6 by clinician burnout, administrative barriers, and a lack of trained behavioral health clinicians, many states7 remain ill-equipped to meet the demand for services. Behavioral health organizations have also experienced quick shifts from in-person care to almost exclusively using telehealth in just a few short months to provide services during the pandemic. In fact, research8 shows that telehealth use during the pandemic was driven more by patients seeking mental health services than for physical needs. While access remains critically important, ensuring patients receive high-quality care is also essential. At the same time, payers are shifting9 towards valuebased payment models that incentivize high-quality and cost-effective care. The crisis of the past two years has shined a bright light on the immediate need for effective and efficient behavioral healthcare. At Owl, we join the resounding research10 and leaders in behavioral health who support and advocate for the use of measurement-based care (MBC) to capture and utilize critical data11 to address these challenges today.
To understand today’s behavioral health priorities and how measurement-based care can address them, we surveyed nearly 100 Community Mental Health Center executives in October 2021. This resulting report is an in-depth look at their priorities, perceptions and use of measurement-based care in addressing today’s crisis, and how prepared they feel for value-based care.
What is Measurement-Based Care?

Measurement-based care (MBC) is the practice of using standardized measurements to assess behavioral health patients to inform treatment decisions. Learn more about the practice of MBC and its benefits on our website.


While respondents understand the value of using measurement-based care (MBC), a small percentage are consistently using it

While 83% of respondents report their organization has a knowledge of MBC and believe it could help them with their current priorities and initiatives, only 16% are consistently using MBC.
Respondents overwhelmingly believe a MBC solution could help them with their current priorities and initiatives.

Respondents feel underprepared for value-based reimbursement models

Nearly a quarter of respondents feel a little or not at all prepared for valuebased reimbursement models and of those who reported concerns about value-based reimbursement models, a majority cited data and reporting as obstacles.


The top five priorities of behavioral health executives:

The priorities of the surveyed behavioral health executives align with the priorities of behavioral health organizations as a whole. Leading advocacy organizations including NAMI, the National Council for Mental Wellbeing, and The Kennedy Forum,12 have partnered to outline possible pathways for success to transform mental health and substance abuse care.

Many of these critical elements were reinforced by our survey respondents, including the importance of expanding access to services, measuring clinical outcomes, and assessing and addressing social determinants of health.

However, respondents report the capabilities to execute on these priorities are lacking. The need for solutions that can seamlessly connect clinicians to evidence-based, patient-reported outcomes without adding to the burden of work is a critical component to help organizations make further progress on their current priorities. In fact, respondents overwhelmingly believe a measurement-based care solution could help them meet all of their current priorities and initiatives.


Priorities vs capabilities


Most behavioral health executives report having a knowledge of measurement-based care, yet 84% are not consistently using it

At its simplest definition, measurement-based care (MBC) is13 “The systematic evaluation of patient symptoms before or during each clinical encounter to inform behavioral health treatment.” While 83% of respondents have a knowledge of MBC and every respondent reported it could help them with their current priorities and initiatives, only 16% are consistently using it.

Research14 has consistently shown that the practice of MBC improves patient outcomes15 among various treatments, populations, and settings. MBC enhances16 clinical decision making and quality of care, enriches17 communications between patient and provider, and can demonstrate18 the value of treatment.

Unfortunately, it’s still not the standard19 of care in practice. A 2019 MBC literature analysis20 revealed that “typically less than 20% of behavioral health practitioners [are] integrating it into their practice,” aligning with the results of our survey.

Common barriers to using MBC in practice include the potential impact on patient schedules and clinical workflows, lack of technology to implement assessments, and the perception21 that measures are time consuming, cumbersome, and/or complicated.

Innovative technology, like Owl’s measurement-based care platform, removes these barriers. Owl automates measurement-based care to lessen administrative burden and reduce clinician burnout. Patients are engaged to complete evidence-based measures when and how they want.

Moreover, Owl provides actionable data that enhances clinical workflows, including insight into when patients should transition into different levels of care or are candidates for discharge. Patients benefit by receiving the right treatment, at the right time, for the right amount of time. Clinicians benefit by providing more rewarding and efficient care, and organizations benefit by being able to serve more patients.


Organizations believe a measurement-based care solution would help them meet their current priorities


More than one-third of executives report not gathering patient-reported outcome measures (PROMs)

From paper forms, to the EHR, to inconsistent methods, the survey suggests gathering data to support clinical decision-making is a pain point for behavioral health executives. In fact, 34% aren’t yet gathering patient-reported outcomes and 28% aren’t gathering or are unsure if they are gathering social determinants of health information.

The National Quality Forum defines22 PROMs as “any report of the status of a patient’s (or person’s) health condition, health behavior, or experience with healthcare that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.”

Core to measurement-based care, research23 has shown using PROMs can help inform clinical decision-making to provide higher quality care. Plus, PROMs play24 an important role in value-based care by incorporating patient reported outcomes for improvement in quality and cost of care.


The majority of behavioral health organizations surveyed are collecting social determinants of health (SDOH) information

According to the National Alliance on Mental Illness (NAMI)25, a “focus on social determinants of health can lead to better mental health outcomes, including preventing mental illness.” New research26 on how social inequities in health “profoundly and unevenly impacted COVID-19 morbidity and mortality” has put a renewed focus on the importance of using social determinants of health (SDOH) in care.

One obstacle27 to implement a process or structure to collect this data is asking already stretched providers to do “one more thing.” And, using the EHR to collect data is often limited, cumbersome, or requires an extensive28development process.

Ultimately, behavioral health executives need to make it seamless to collect PROMs and SDOH data to use in clinical workflows and population health management to provide higher quality care and improve outcomes. The good news is technology providers, like Owl, have developed solutions that make capturing and using patient data a unified part of the care that clinicians provide.

“Owl is at a whole new level, available at the convenience of the patient. The scheduling functionality and how the providers view the information over time is really superior—so much better than what we were able to do with our EMR.”

– Tamara Player, CEO, Polara Health


An overwhelming majority of organizations have fee-for-service contracts

Nearly a quarter of respondents feel “a little” or “not at all” prepared for value-based reimbursement models

One major barrier to improving access to behavioral health services is related to payment. Research supports shifting to value-based reimbursement to increase payment for providers who can demonstrate improved population health and cost efficiencies.

Of those who have concerns about value-based reimbursement, more than half cite data concerns

According to our survey, a key challenge is a lack of evidence-based outcomes data that demonstrate that providers are offering quality care. How can behavioral health organizations capture and use population health data in preparation for valuebased reimbursement that doesn’t add to clinician burden? We believe there is a way forward with data-driven technology platforms, like Owl, that help behavioral health organizations capture, report, and analyze data at both the individual and population level to support value-based care.
“Partnering with Owl was an obvious choice for us. Not only will the data from Owl help us demonstrate to payers that we deliver effective client care, but the Owl platform will engage clients in their treatment and give clinicians easy-to-use tools, leading to improved clinical outcomes.”

– Jeremy Blair, CEO, WellStone


Three major takeaways

Thank you to the behavioral health executives who provided their time and expertise to contribute to this report. The data from this survey tells a story of behavioral health organizations working tirelessly to employ exceptional clinical staff, expand access to services to better deliver the right treatment to the right people at the right time, and use evidencebased guidelines to improve care and better measure outcomes.

It also shows these organizations need additional capabilities—in the form of people, processes, or technology, to better meet today’s priorities. While each organization may interpret these survey findings in the way most helpful for their own strategies, there are three major takeaways.

\If you have any questions about the survey or if you’d like to learn more about how Owl helps behavioral health organizations like Ascension, Inova Health, Polara Health, and Recovery Centers of America improve clinical outcomes, expand access, and prepare for value-based care, please contact us.

About Owl

Owl gives behavioral health organizations better data, better insights, and better outcomes with its data-driven, evidence-based solutions. Leading organizations, including Ascension, Inova Health, Polara Health, and Recovery Centers of America, rely on Owl to expand access to care, improve clinical outcomes, and prepare for value-based care. Owl makes measurement-based care easy to engage patients, optimize treatment, improve care, reduce clinician burden, and capture data to optimize business performance.

About mhca

mhca is a national association of innovative, entrepreneurial behavioral healthcare organizations focused on the development of C-suite executives. mhca is a results-oriented organization that operates in a fast, flexible, and focused mode. We take pride in the purposeful and productive involvement and participation of our members. Because mhca is composed of members who share common visions and priorities, we are able to quickly determine our objectives, commit the necessary resources, and accomplish our goals. To learn more, please visit


1, 5 Mental Health America. (2020, 10 20). 2021 State of Mental Health in America. Mental Health America. RetrievedFebruary 23, 2022, from

2 Kearney, A., Hamel, L., & Brodie, M. (2021, April 14). Mental Health Impact of the COVID-19 Pandemic: An Update. KFF. Retrieved February 23, 2022, from

3 Lane, R. (2020, August 14). Mental Health, Substance Use, and Suicidal Ideation During the … CDC. Retrieved February 23, 2022, from

4 Sancho, M. C., Parker-Pope, T., & Caron, C. (2021, December 16). Why Therapists Are Worried About America’s Growing MentalHealth Crisis. The New York Times. Retrieved February 23, 2022, from

6 National Council for Mental Wellbeing. (ND). Immediate-Policy-Actions-to-Address-the-National-Workforce-Shortage-and-Improve-Care- National Council. National Council for Mental Wellbeing. Retrieved February 23, 2022, from

7 Mental Health America. (ND). Ranking the States 2022. Mental Health America. Retrieved February 23, 2022, from

8 Wicklund, E. (2021, January 12). Telehealth Survey Sees More Users for Behavioral Health Than Physical Care.
mHealthIntelligence. Retrieved February 23, 2022, from

9 National Council for Mental Wellbeing. (ND). Value-Based Care for Behavioral Health. National Council for Mental
Wellbeing. Retrieved February 23, 2022, from

10 The Kennedy Forum. (2015, ND ND). Fixing Behavioral Health Care in America. The Kennedy Forum. Retrieved February 23, 2022, from

11 Meier, E. (2021, October 20). From Intuition To Quantification: Using The Power Of Data To Expand Access To Care And Improve Clinical Outcomes In Behavioral Health. MedCity News. Retrieved February 23, 2022, from

12 Mental Health America. (2020). A Unified Vision for Transforming Mental Health and Substance Use Care. Mental
Health America. Retrieved February 23, 2022, from

13 Owl. (2022). What Is Measurement-Based Care? Measurement-based care.

14 Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J., Smith, R., Schoenbaum, M., & Harbin, H. (2017). A Tipping Point for Measurement-Based Care. Psychiatric Services, 68(2), 179-188.

15, 21 Aboraya A., Nasrallah H.A., Elswick D.E., Ahmed E., Estephan N., Aboraya D., Berzingi S., Chumbers J., Berzingi S., Justice J., Zafar J., Dohar S. (2018). Measurement-based Care in Psychiatry-Past, Present, and Future. Innov Clin Neurosci. 15(11-12):13-26.

16, 17 Martin-Cook K., Palmer L., Thornton L., Rush A.J., Tamminga C.A., Ibrahim H.M. (2021). Setting Measurement-
Based Care in Motion: Practical Lessons in the Implementation and Integration of Measurement-Based Care
in Psychiatry Clinical Practice. Neuropsychiatr Dis Treat, 17, 1621-163.

18 Harding K.J., Rush A.J., Arbuckle M., Trivedi M.H., Pincus H.A. (2011). Measurement-Based Care in Psychiatric Practice: A Policy Framework for Implementation. J Clin Psychiatry. 72(8):1136-43.

19, 20 Lewis C.C., Boyd M., Puspitasari A., Navarro E., Howard J., Kassab H., Hoffman M., Scott K., Lyon A., Douglas
S., Simon G., Kroenke K. (2019). Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA
Psychiatry. 76(3):324-335.

22 National Quality Forum. (2012). NQF: Patient-Reported Outcomes in Performance Measurement. National
Quality Forum. Retrieved February 23, 2022, from

23, 27 Rivera, S.C., Kyte, D.G., Aiyegbusi, O.L., Slade, A.L., McMullen, C., Calvert M.J. (2019).. The Impact of Patient-
Reported Outcome (PRO) Data From Clinical Trials: A Systematic Review and Critical Analysis. Health Qual Life
Outcomes. 17: 156.

24 Squitieri, L., Bozic, K. J., & Pusic, A. L. (2017). The Role of Patient-Reported Outcome Measures in Value-Based
Payment Reform. Value in Health : The Journal of the International Society for Pharmacoeconomics and Outcomes
Research, 20(6), 834–836.

25 Ponte, K. (2020, August 6). Ways We Can Address the Social Determinants of Mental Health. NAMI. Retrieved
February 23, 2022, from
Determinants-of-Mental-Health Respiratory medicine, 8(7), 659–661.

28 Gold, H. T., Karia, R. J., Link, A., Lebwohl, R., Zuckerman, J. D., Errico, T. J., Slover, J. D., Buckland, A. J., Mann,
D. M., & Cantor, M. N. (2020). Implementation and early adaptation of patient-reported outcome measures into an
electronic health record: A technical report. Health Informatics Journal, 129–140.

29 Knutson, K. H., Wennberg, D., Rajkumar, R. (2021). Driving Access and Quality: A Shift to Value-Based Behavioral
Health Care. Psychiatric Services, 72(8), 943-950.

30 Panchal, N., Kamal, R., Cox, C., & Garfield, R. (2021, February 10). The Implications of COVID-19 for Mental Health
and Substance Use. KFF. Retrieved February 23, 2022, from