What health plans should measure before scaling asynchronous behavioral health

Health plans have spent years trying to improve access to behavioral healthcare, particularly for members who cannot find a therapist, have difficulty fitting appointments into their schedules or never make an appointment after receiving a referral. Asynchronous models offer another way to reach some of these members, raising a practical question for health plans about whether easier access translates into meaningful treatment and measurable improvement.

I learned this while building an asynchronous psychotherapy platform and deploying it with health plans. Early on, we collected brief two-item symptom screeners that were useful for monitoring members, but they could not demonstrate whether treatment was producing meaningful clinical improvement. As our contracting evolved toward payment tied to outcomes, we had to become much more disciplined about what we measured and when.

Working under outcome-based contracts changed how I evaluated whether an asynchronous model was actually delivering meaningful care. Health plans evaluating these models need to know whether members receive enough treatment to have a reasonable opportunity to benefit. Registration is useful operationally, but it says little about treatment. Even initiation can overstate success if a member begins and quickly disengages. Plans should define an effective dose for the particular model and track how many referred members reach it. In our case, that meant looking at completion of three or more sessions alongside symptom change measured through the Patient Health Questionnaire and General Anxiety Disorder assessments.

Digital behavioral health can produce strong engagement numbers that create the appearance of success without establishing whether members actually received meaningful care. For a health plan, the questions that matter begin after a member enters the program. Did the member begin treatment, receive a clinically meaningful amount of treatment and improve? Did symptoms worsen or indicate the need for additional care? Answering these questions tells health plans considerably more about clinical value than registrations, clicks or time spent in an application.

Clinical outcomes also have to be evaluated within clear safety boundaries that define who is appropriate for asynchronous care and what happens when a member’s needs exceed the model’s capabilities.

In our deployments, validated screening is part of intake, with exclusion criteria for acute or unstable presentations. Signals such as suicidal ideation, psychosis indicators or rising acuity require defined pathways to immediate human contact and, when necessary, live therapy or a higher level of care.

The care pathway between referral and treatment also affects whether improved access leads to actual participation. We saw this when adding a synchronous step to an asynchronous care pathway reduced participation, particularly among members who had chosen the model because it offered a more private and flexible way to begin treatment. The deployment worked better when the care pathway remained consistent with the experience members had originally chosen.

Tracking who actually began treatment

What happens clinically after a member enters care provides the most meaningful evidence of whether a newer behavioral health model is working. Our approach has been to look beyond initial uptake and track how many members actually begin treatment, how many receive enough care to benefit, changes in their symptoms and the model’s ability to identify people who need a different level of support. These outcomes show how effectively expanded access translates into care for people who might otherwise have gone untreated.

Asynchronous behavioral health can expand the capacity of a system that does not have enough clinicians to meet demand, particularly among people for whom scheduling, stigma or the structure of traditional therapy has kept care out of reach.

After building and deploying this model at scale, I believe its greatest potential lies in bringing effective treatment to people the existing system has struggled to reach while preserving clear standards for outcomes, safety and appropriate escalation.

The opportunity now is to make access to behavioral health care easier without lowering our expectations for what that care should accomplish.

Sushant Gupta, MBA, is the founder and CEO of Meomind, a digital behavioral health company.