TPN.health CEO and co-founder Trevor Colhoun is featured in the September/October 2026 issue of the Journal of Compensation and Benefits with an article on the infrastructure behind behavioral health access. Published by Thomson Reuters six times a year, the journal is a professional resource for the HR and benefits leaders responsible for their organizations’ compensation and benefits plans.
Employers have expanded mental health benefits, and provider networks keep growing, so why do employees still struggle to get care? Our answer is that the problem isn’t a shortage of benefits or providers. It’s the infrastructure connecting the two. Outdated directories and “ghost networks” leave members cold-calling providers who aren’t taking patients, have moved, or no longer accept their plan. Each failed connection is a benefit investment with no return, and those costs show up later as absenteeism, disability claims, and higher medical spend.
Trevor also lays out what benefits professionals should measure instead of network size: connection success rates, time to care, and real-time visibility into whether employees are actually reaching treatment.
Read the entire article below.
This article originally appeared in the September/October 2026 issue of Journal of Compensation and Benefits.
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Behavioral Health Infrastructure: Ghost Networks and the Hidden Cost of Behavioral Health Access
By Trevor Colhoun, CEO
Despite significant investments in expanding behavioral health benefits and provider networks, many employees still struggle to access care due to “ghost networks” and lack of real-time infrastructure to connect individuals with available resources. Benefits professionals should prioritize vendors that measure whether employees actually get appointments and how quickly they receive care, rather than simply counting network providers, and that offer real-time tracking across the fragmented behavioral health system.
The Behavioral Health Access Paradox
Benefits professionals are facing a “value proposition crisis” in behavioral health.¹ Over the past decade, we have watched employers expand mental health benefits, health plans broaden their behavioral health offerings, and organizations pour resources into workforce wellbeing programs.² Meanwhile, demand for behavioral health services continues to grow. Nearly one in five U.S. adults experiences mental illness, and millions seek care each year for conditions ranging from anxiety and depression to substance use disorders and other behavioral health challenges.³ That is real demand from real people in your member life populations. On paper, the market looks more resourced than ever. In reality, many members still do not know where to start.
Despite these investments, many employees continue to encounter difficulties when attempting to access care.⁴ The stories are heartbreakingly consistent with lengthy provider searches that lead nowhere, delayed appointments that stretch for weeks, and unsuccessful attempts to connect with treatment that leave people more frustrated than when they started.
For benefits professionals, this creates a “ghost network paradox.” Behavioral health benefits may be available, networks may appear robust, and significant resources may be allocated to supporting employee mental health, yet many members still struggle to access timely care. Said otherwise, the benefit exists, but the market still fails at the moment the member needs it to work.
The behavioral health market has essentially become a “black market” where the infrastructure connecting supply and demand is fundamentally broken. We are not talking about a simple workforce shortage or benefit designs issue here—those are symptoms, not the disease.
The real problem is that our current system treats behavioral health access like a very analog, siloed, and bifurcated industry. Members are expected to navigate outdated provider directories where much of the information is inaccurate. They are making cold calls to providers who may or may not exist, may or may not be taking patients, and may or may not actually specialize in their specific condition. Every failed connection attempt represents cost avoidance that never materializes. Every delayed treatment represents a member life that deteriorates instead of improves. Every frustrated employee represents a benefit investment with zero return.
This disconnect is becoming increasingly important as behavioral health moves from a supplemental offering to a strategic component of workforce health and benefits planning. Employers are under growing pressure to demonstrate that benefit investments are producing meaningful value for employees while also supporting broader organizational goals related to productivity, retention, and healthcare spending. The challenge raises an important question for benefits leaders. If behavioral health investment continues to rise and provider networks continue to expand, why do access challenges persist?
The answer may lie beyond traditional discussions about workforce shortages, benefit design, or coverage levels. While each of those factors influences access, they do not explain why members frequently encounter obstacles even when behavioral health resources appear readily available.⁵ The deeper issue is value, visibility, and connectivity. Understanding that gap requires a closer examination of how behavioral health access functions in practice and the factors that influence whether available benefits ultimately translate into meaningful care.
Network Adequacy and Actual Access
Measuring Networks
Behavioral health network adequacy has long served as an important benchmark for evaluating access to care. Health plans, regulators, and employers frequently assess networks using measures such as provider participation, geographic coverage, and appointment availability standards. These metrics provide valuable information about a network’s structure and help determine whether sufficient resources exist to support covered populations.
The Employee Experience
For benefits professionals, however, an important distinction exists between network adequacy and the employee experience. A network may satisfy established standards while individuals continue to encounter challenges when seeking care. The existence of participating providers does not automatically guarantee that employees can readily identify appropriate treatment options, secure appointments, or connect with care that aligns with their clinical needs and personal preferences.
Behavioral healthcare differs from many other healthcare services in this regard. A person seeking treatment often evaluates multiple factors simultaneously, including clinical specialty, treatment approach, demographic considerations, location, scheduling flexibility and insurance participation. What appears to be a large network on paper may represent a much smaller pool of realistic options once these individual requirements are considered.
This distinction becomes increasingly important as employers evaluate the effectiveness of behavioral health benefits. Traditional measures often focus on the availability of resources within a network. Employees, however, judge access based on outcomes. From their perspective, success is measured by whether they can connect with appropriate care when needed, not by network size.
Understanding that distinction is an important first step because it reveals that access challenges can persist even when networks appear sufficient. The factors contributing to that disconnect become more visible when examining one of the most widely recognized challenges in behavioral healthcare today—ghost networks.
Ghost Networks: The Visibility Problem
Ghost networks have attracted increasing attention from regulators, health plans, employers, and patient advocates because they affect one of the most critical moments in the care journey—the initial search for treatment.⁶ The term describes provider listings that no longer accurately reflect current circumstances, creating the appearance of available care that may be difficult or impossible to access in practice.
An employee may locate a provider listed within the network, only to discover that the phone number is no longer active. Another may contact multiple clinicians before learning that they are not accepting new patients. Others may find that a listed provider has changed locations, altered insurance participation, or is no longer practicing in the capacity reflected by the directory.
For benefits professionals, ghost networks create a visibility challenge—a gap between what a network appears to offer and what individuals encounter when they begin searching for care.
Why Static Directories Fail
A Continuously Changing Environment
Provider directories were designed to serve a straightforward purpose, helping individuals locate participating healthcare professionals. The challenge is that behavioral healthcare is not a static environment. It is a constantly evolving ecosystem that changes more rapidly than periodic update cycles can accommodate.
The Limits of Periodic Updates
Traditional provider directories are typically built around scheduled verification processes. Information is collected, reviewed, updated, and published at designated intervals. While this approach may be sufficient in environments where provider characteristics remain relatively stable, behavioral healthcare often changes more rapidly than those update cycles can accommodate.
As a result, a directory may accurately reflect provider information at the moment it is updated while becoming progressively less representative as conditions change. The issue is not necessarily the quality of the information collected. Rather, it is the difficulty of maintaining an accurate picture of a network that continues to evolve after the information is recorded.
This challenge becomes particularly pronounced in behavioral healthcare because provider participation alone does not fully capture the characteristics that influence care availability. Practice status, patient acceptance, treatment focus, and service delivery models may shift between update cycles, creating a growing disconnect between recorded information and current conditions.
The limitations of static directories highlight an important reality. Behavioral health networks are dynamic by nature. Any system designed to represent them must contend with continuous change occurring across thousands of individual providers, practices, and treatment settings. When the pace of change exceeds the pace of updates, maintaining an accurate view of network conditions becomes increasingly difficult.
Understanding these limitations helps explain why information gaps emerge but it also raises a broader question. If accurate access depends on more than maintaining provider lists, what systems are necessary to support behavioral health access at scale?
The Infrastructure Gap
Defining Infrastructure
Infrastructure is rarely the first topic discussed in conversations about behavioral healthcare. More often, attention centers on providers, patients, treatment demand, or benefit design. Yet behind every successful connection to care exists a set of systems, processes, and relationships that help make that connection possible.
In practical terms, infrastructure refers to the operational foundation that supports how behavioral health services are identified, coordinated, and accessed. It encompasses the mechanisms through which information moves across the behavioral health ecosystem and the structures that help connect individuals with appropriate care resources.
A Decentralized Ecosystem
Many healthcare sectors have undergone significant operational modernization over the past two decades.⁷ Scheduling systems, referral workflows, data exchange capabilities, and care-coordination processes have become increasingly integrated into how services are delivered and managed. Behavioral healthcare has often evolved differently. A large portion of the provider community continues to operate through independent practices, small group settings, and diverse organizational structures, creating a more decentralized environment.
This decentralization creates infrastructure challenges. Thousands of clinicians operate across different specialties, treatment modalities, practice settings, and geographic markets through independent practices and small group settings. Unlike systems built around a limited number of large institutions, maintaining operational visibility and coordination across this fragmented landscape requires different technological and administrative capabilities.
The Hidden Cost of Failed Access
Employee Impact
When behavioral health needs go unaddressed, the effects often extend far beyond the individual search for care.⁸ What begins as an inability to connect with treatment can influence workforce wellbeing, organizational performance, and healthcare utilization in ways that may not be immediately visible.
For employees, untreated behavioral health conditions can affect daily functioning, concentration, decision-making, and overall quality of life. The impact is often felt across both personal and professional responsibilities.
Employer Impact
Employers experience these effects through multiple channels. Behavioral health concerns are associated with absenteeism, presenteeism, disability claims, workforce turnover, and reduced productivity.
Healthcare spending may also be affected, as behavioral health conditions frequently coexist with physical health conditions, creating compound costs when mental health needs remain unaddressed.⁹ Emergency department visits, primary care utilization for behavioral health symptoms, and disability claims often increase when employees cannot access appropriate behavioral health support.
The Emergence of Modern Behavioral Health Infrastructure
Attention is increasingly shifting toward the systems that support access rather than focusing exclusively on the benefits themselves. This shift reflects recognition that maintaining effective connections across providers, health plans, employers, and individuals requires capabilities that extend beyond traditional administrative functions.
Several specific approaches are emerging: real-time provider engagement rather than periodic information collection, sophisticated network intelligence that tracks provider characteristics, participation, and activity, continuous verification processes that improve confidence in network information, and coordination platforms that create stronger connectivity between all ecosystem participants rather than treating them as separate components.
What Benefits Professionals Should Evaluate Next
Looking Beyond Availability
Benefits professionals should evaluate vendor capabilities that provide visibility into employee care journeys, measure connection rates between initial outreach and completed appointments, and track resolution timeframes for access requests.
Evaluating Real-World Performance
This infrastructure evolution fundamentally changes how benefits professionals should evaluate behavioral health vendors. Traditional assessments focused on network size and coverage breadth. Modern evaluation requires examining operational capabilities that demonstrate actual care connectivity.
Key performance indicators (KPIs) now include connection success rates, the percentage of employees who successfully schedule appointments after initial outreach, and time-to-care metrics that measure how quickly individuals move from expressing need to beginning treatment. Benefits professionals should also evaluate vendors’ ability to provide real-time visibility into employee care journeys and track resolution outcomes for access requests.
The most effective behavioral health strategies demonstrate measurable improvements in employee experiences rather than simply documenting resource availability. This means assessing whether vendor systems can identify and resolve access barriers as they occur, not just report network statistics after problems have already affected employees.
As behavioral health benefits mature, evaluation frameworks will likely emphasize care completion rates and employee satisfaction with the access process. For employers seeking to maximize their behavioral health investments, vendor capabilities that transform theoretical network access into successful care experiences represent the critical differentiator in benefits strategy.
Building Behavioral Health Benefits That Work
Behavioral health has entered a new phase within benefits strategy. What was once viewed primarily as a coverage issue is increasingly being recognized as an operational challenge that requires thoughtful coordination across a complex and evolving care landscape.
For benefits professionals, this shift reflects a broader change in expectations. Employees evaluate behavioral health benefits through lived experience. The measure of success is whether support can be reached when it is needed and whether available resources ultimately translate into meaningful care.
The path forward requires moving beyond traditional approaches that prioritize network size and coverage breadth toward strategies that emphasize operational excellence and measurable outcomes. This means investing in infrastructure that provides real-time visibility into provider availability, implementing systems that can track and improve employee care journeys, and establishing performance metrics that reflect actual access rather than theoretical availability.
Employers face growing pressure to demonstrate the value of benefit investments while supporting workforce wellbeing in an increasingly complex healthcare environment. Success will increasingly depend on the ability to create experiences that help employees move from need to care with greater confidence, clarity, and consistency.
For benefits professionals, the opportunity is to ensure that the investments being made today produce meaningful value for employees tomorrow. In the years ahead, that objective may become one of the most important measures of behavioral health success.
Trevor Colhoun is the CEO and co-founder of TPN.health, the nation’s digital home for behavioral health providers. In just six years, TPN.health has grown to over 160,000 clinicians across all 50 states, with thousands joining every month. The platform has powered over 450,000 continuing education hours and more than 300,000 events, making it the most trusted space for providers to connect, learn, and advance their professional growth. Under Mr. Colhoun’s leadership, TPN.health has expanded into a next-generation ecosystem that unites providers, payers, and patients. His background spans private equity, organizational leadership, and philanthropy, where he has served on boards including The Millbrook School in New York and SBP in New Orleans. Today, he is leading TPN.health and the behavioral health industry toward a provider-first future.
Notes
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“2026 Employer Health Care Strategy Survey Executive Summary,” Business Group on Health (Aug. 19, 2025), https://www.businessgrouphealth.org/resources/2026-employer-health-care-strategy-survey-executive-summary
“Mental Health by the Numbers,” National Alliance on Mental Illness (NAMI) (2025), https://www.nami.org/mental-health-by-the-numbers/
“State of the Behavioral Health Workforce, 2025,” National Center for Health Workforce Analysis, Health Resources and Services Administration (Dec. 2025), https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/Behavioral-Health-Workforce-Brief-2025.pdf
“Mental Health Care Health Professional Shortage Areas (HPSAs),” KFF (as of Dec. 31, 2025), https://www.kff.org/other-health/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
“American Psychiatric Association Files Class Action Complaint Against EmblemHealth, Inc.,” American Psychiatric Association (Jan. 8, 2026), https://www.psychiatry.org/news-room/news-releases/apa-class-action-complaint-against-emblemhealth
Patel and Singhal, “What to Expect in US Healthcare in 2026 and Beyond,” McKinsey & Company (Jan. 12, 2026), https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare
Chen, “Re-Evaluating Access in Healthcare: Focus on Quality of Care,” Public Health Challenges (Nov. 11, 2025), https://onlinelibrary.wiley.com/doi/10.1002/puh2.70100
Hanna et al., “Co-Occurrence Between Mental Disorders and Physical Diseases: A Study of Nationwide Primary-Care Medical Records,” Psychological Medicine (Nov. 18, 2024), https://www.cambridge.org/core/journals/psychological-medicine/article/cooccurrence-between-mental-disorders-and-physical-diseases-a-study-of-nationwide-primarycare-medical-records/DCACA27CF1E22647C08856CEE47EBBE0