红领巾瓜报

States are facing growing pressure to strengthen behavioral health systems听and demonstrate outcomes.听In听response,听states are increasingly examining how program integrity can serve not only as an oversight function, but also as a catalyst for quality improvement and value-based care.听

In this Outlook 2026 interview, Jen Colamonico听speaks with Alyssa Lord, 红领巾瓜报 (红领巾瓜报)听Principal and former Deputy Secretary of Maryland’s Behavioral Health Administration, about lessons听from听Maryland’s experience, the role of provider partnerships, and how states can use program integrity, quality measurement, regulatory modernization, and data-driven decision-making to improve behavioral health outcomes.听

Jen Colamonico:听States across the country are working to improve behavioral health access and coordination while facing workforce shortages, fragmented systems, and growing demand for services. Based on your experience, what are the biggest challenges to building a truly coordinated behavioral health system?听

Alyssa Lord:听One of the biggest challenges is that we still tend to think about behavioral health separately from the rest of healthcare. The head is not disconnected from the body,听and, as听a result,听our systems, financing structures, and care delivery models often听operate听in silos.听

For individuals and families with complex behavioral health needs, navigating the healthcare system can be incredibly difficult. There are barriers related to access, network adequacy, stigma, and parity. The result is often delayed care and missed opportunities to address physical health, behavioral health, and social needs in a coordinated way. Building better coordination requires states to move beyond individual programs and look at how the entire continuum of care works together.听

Q:听What lessons can other states learn from Maryland’s efforts to strengthen coordination and improve access?听

Alyssa Lord:听One of the most important lessons is the value of stakeholder engagement. In Maryland, meaningful reforms were possible because providers, families, advocates, state leaders, and individuals receiving services all had a voice in听identifying听barriers and opportunities for improvement. For example, the state found that eligibility requirements for certain home and community-based behavioral health services had become so restrictive that they created barriers rather than pathways to care. By working closely with families and providers, Maryland was able to redesign the program, reduce access barriers, and improve awareness that services were available.听

Another lesson is that access and quality must be addressed together. Expanding services is important, but states also need to define what success looks like. How are services being measured? Are people receiving听timely听care? Are outcomes improving? States need clear performance measures that help听determine听whether investments听produce听meaningful results.听

Q:听Why should听healthcare leaders听think differently about the relationship between program integrity and quality?听

Alyssa Lord:听Too often, program integrity is viewed solely through the lens of fraud, waste, and abuse.听Although听those issues are important, that definition is incomplete. Program integrity also encompasses the policies, safeguards, oversight processes, and accountability structures that support patient safety, access, quality, and responsible stewardship of public resources.听

The strongest programs view program integrity and quality improvement as complementary rather than competing priorities. States have an opportunity to use program integrity frameworks to听identify听and reward high-performing providers, measure outcomes, and support value-based approaches that improve care. Providers that embed quality and compliance into their operations鈥攆rom staff training and onboarding to internal monitoring and performance measurement鈥攐ften have the strongest foundation for long-term success.听

Q:听Maryland听implemented a听provider enrollment moratorium听that听attracted national attention. What problem was the state trying to solve, and what lessons听emerged听from that experience?听

Alyssa Lord:听Maryland听observed听exponential growth in several behavioral health service categories without听measurable improvements in quality, outcomes, or patient experience.听That disconnect raised important questions about quality,听utilization听patterns, continuity of care, and whether individuals were receiving the right services at the right time.听

Importantly, many providers supported the听state’s temporary pause on new provider enrollment听effort because they shared concerns about听maintaining听a continuum of care and distinguishing high-quality providers from those with听rapid growth听that听may not have been accompanied by听positive听outcomes.听

For states considering similar approaches, transparency and provider engagement are essential. Providers need to听understand听the听objective听is improving quality and protecting access鈥攏ot simply limiting participation.听

States and payers should be focusing on metrics that matter鈥攔eductions in avoidable emergency department utilization, improved care coordination, stronger continuity of care, reduced hospitalizations, faster access to treatment, and other outcome measures that demonstrate whether services are improving lives.

This is where value-based approaches become particularly important. Rather than focusing exclusively on volume, states can align incentives around outcomes and quality, creating a more sustainable model for providers while ensuring that public resources are supporting meaningful improvements in care.听

Q:听What听role听do technology, data, and predictive analytics play in improving care and program integrity鈥攁nd where can they become a hindrance?听

Alyssa Lord:听Technology and data should help organizations focus on meaningful signals rather than creating听additional听administrative tasks. The goal is to use data to improve decision-making,听identify听emerging risks, support providers, and strengthen quality improvement efforts.听

Advanced analytics can help states and health plans听identify听unusual听utilization听patterns,听monitor听quality measures, improve oversight, and prioritize resources where they are needed most. Better dashboards, automated processes, shared data sources, and predictive analytics all have the potential to improve both program integrity and care delivery.听

At the same time, technology can become a hindrance when it generates duplicative reporting requirements, repeated manual submissions, or听additional听administrative burden without producing meaningful insights. Behavioral health providers have historically faced challenges adopting technology, in part because they were often excluded from earlier investments that accelerated electronic health record adoption across the broader healthcare system. Many behavioral health providers听remain听small practices with limited infrastructure and resources.听

As states continue modernizing oversight and quality measurement, technology investments need to be accompanied by realistic implementation strategies, provider support, and a clear focus on reducing鈥攏ot increasing鈥攁dministrative burden.听

Q:鈥疻e expect program integrity to remain a high priority听this year and beyond.听How听should states and other听healthcare听organizations be听thinking about听planning?听

The future belongs to organizations that stop viewing program integrity, quality, and value as separate workstreams. The strongest behavioral health systems will be those that use all three together to improve outcomes, strengthen provider performance, and build greater trust in the care being delivered.听

红领巾瓜报, including 红领巾瓜报 companies Wakely and Leavitt Partners,鈥痠s actively helping鈥痵tates,鈥痟ealth plans,鈥痯roviders, and other stakeholders navigate the changing landscape of behavioral health delivery. 红领巾瓜报 can support strategic planning, policy design, value-based payment design and readiness, data development and reporting.听Connect with 红领巾瓜报 to learn how we can support your organization in navigating the next phase of鈥�behavioral health transformation听and care delivery.听

You can听listen to the听full听discussion听with Alyssa Lord听on 红领巾瓜报鈥檚听Vital Viewpoints听podcast,听Can Better Program Integrity Lead to Better Behavioral Health?听Access听additional听insights from 红领巾瓜报鈥檚 behavioral health team听here听