Beyond Access: What Eating Disorder Care Reveals About the Entire Behavioral Health System

When we talk about fixing behavioral health, the conversation almost always starts and ends with access. But what if access to the wrong care, or fragmented care, is just as damaging as no care at all?

That was the central argument in a recent NovaOne webinar, where Janice Rybicki, Director of Client and Provider Success at NovaOne, and Caitlin Defiore Donovan, VP of Payer Strategy and Partnerships at Equip, used eating disorder care as a case study to expose deeper, systemic failures across the entire behavioral health landscape and lay out a practical framework for fixing them.

Starting With a Story
Caitlin opened by sharing the story of Equip's founder and CEO, Kristina Saffran, who was first diagnosed with anorexia at 15 and spent nearly seven months across multiple inpatient stays - missing school, losing friendships and watching treatment consume her entire life. After a final residential stint, her family was told she had little chance of recovery. Her parents refused to accept that outcome. Through research, they found Family Based Therapy (FBT), a treatment model that equips patients and their families with the skills and resources to address eating disorders at home. FBT led to Kristina’s full and lasting recovery - and eventually to the founding of Equip. Kristina’s story, Caitlin noted, should be the standard. Today, it remains the exception. And understanding why is the key to transforming the system.

The Real Crisis Isn't Access - It's Efficacy
The numbers paint a stark picture. Five million Americans are affected by eating disorders, yet only 20% receive any care at all. The economic cost of eating disorders in the U.S. runs close to $65 billion annually, accounting for both direct treatment costs and indirect impacts like lost productivity and caregiver strain.

But here's the harder truth: even for those who do access care, the system often fails them. As Caitlin put it, focusing on access alone is a dangerous oversimplification. The real crisis is one of efficacy - care models that are fragmented, reliant on outdated methods and unable to treat the whole person in their real-world environment. The result is a devastating cycle of relapse and readmission.

Eating Disorders as a Stress Test for the System
Janice framed eating disorders as a lens through which we can see the entire behavioral health system's weaknesses clearly. Several fractures come into sharp focus:

Medical and psychiatric complexity. Care remains siloed. A child with ARFID might start with a pediatrician, get referred to a GI specialist and then to a mental health provider - with each clinician seeing only a fragment of the person. Coordinated, sustained care is the exception, not the rule.

Family system involvement. Evidence-based treatments like FBT rely on family participation, but family coaching and peer support often aren't covered benefits. Families who need to be part of the solution are frequently left on their own to figure it out.

Long-term care coordination. Behavioral health tends to be measured in episodes - number of admissions, length of stay. But eating disorders, like many high-acuity conditions, require sustained, longitudinal support to achieve lasting recovery. Measuring by episode misses the whole picture.

Fragmentation at transition points. The moments between levels of care - leaving residential treatment, waiting on an outpatient authorization - are when patients are most vulnerable. Delays in those transitions are a leading driver of relapse and readmission. For eating disorders specifically, that fragmentation can be life-threatening.

Three Pillars of a Resilient Behavioral Health System
So what does a better system look like? Janice outlined three foundational pillars:

1. Accountability - Shifting from Fee-for-Service to Value-Based Models Paying for encounters rather than outcomes means providers are rewarded for volume, not results. Moving toward value-based models aligns everyone around the same goal: helping members achieve real, lasting improvement.

2. Coordination - Breaking Down Silos True multidisciplinary care means that mental health, physical health and family support are no longer operating in separate lanes. It means shared treatment plans, aligned teams and care pathways that don't leave members stranded between systems.

3. Specialization - Building Pathways to Evidence-Based Care For high-acuity conditions, having a provider is not enough - members need access to providers who specialize in evidence-based treatments for their specific condition. Finding, vetting and deeply integrating those specialty partners into the health plan ecosystem is a strategic imperative.

What Health Plans Can Do Right Now
Network strategy and value-based contracting. Assess whether your network includes providers who specialize in high-acuity conditions, not just providers in general. For conditions like eating disorders, the number of true specialists may be small - and that scarcity needs to be part of your strategy. Then work toward contracts that reward outcomes, not just activity.

Data infrastructure and outcomes measurement. Claims data tells an incomplete story. Building systems to track clinical and financial outcomes in real time gives health plans a much clearer picture of whether their members are actually getting better - and where the gaps are.

Member identification and care navigation. You can bring on the best specialty provider in the world, but if members - and internal case managers, pediatricians and primary care physicians - don't know how to find them or refer to them, it won't matter. Building care pathways and ensuring that everyone in the system knows how to connect members to the right treatment is essential.

Operational excellence. Administrative and technical friction is not a minor inconvenience in behavioral health. A delayed prior authorization can have lasting consequences for a member with an eating disorder. Smooth, efficient operations behind the scenes are as important as clinical quality on the front lines.

Applying This Framework Beyond Eating Disorders
One of the most valuable takeaways from the session was that this framework doesn't stop with eating disorders. Janice and Caitlin pointed to several other high-acuity conditions where the same systemic analysis - and the same strategic response - applies: serious mental illness, substance use disorder, pediatric complex behavioral health, maternal mental health and obsessive compulsive disorder.

These conditions share common threads: they sit at the intersection of behavioral and physical health, they carry stigma that delays care-seeking, they require coordinated and sustained treatment, and they are often underserved by a system that hasn't yet built the right infrastructure around them. The questions health plans should be asking are consistent across all of them: Where are we seeing high costs and poor outcomes? What conditions require specialty expertise? And how do we build strategic partnerships - not just transactional contracts - with the providers who can actually move the needle?

Ready to Go Deeper?
The complete recording, slide deck and takeaway handout from the session are now available. Whether you're building out a specialty behavioral health strategy or looking to strengthen your existing approach to high-acuity care, this conversation is well worth an hour of your time - and worth sharing with your team.