States are facing growing pressure to strengthen behavioral health systems and demonstrate outcomes. In response, 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. 

In this Outlook 2026 interview, Jen Colamonico speaks with Alyssa Lord, Health Management Associates (HMA) Principal and former Deputy Secretary of Maryland’s Behavioral Health Administration, about lessons from 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. 

Jen Colamonico: 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? 

Alyssa Lord: 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, and, as a result, our systems, financing structures, and care delivery models often operate in silos. 

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. 

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

Alyssa Lord: 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 identifying 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. 

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 timely care? Are outcomes improving? States need clear performance measures that help determine whether investments produce meaningful results. 

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

Alyssa Lord: Too often, program integrity is viewed solely through the lens of fraud, waste, and abuse. Although 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. 

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 identify and reward high-performing providers, measure outcomes, and support value-based approaches that improve care. Providers that embed quality and compliance into their operations—from staff training and onboarding to internal monitoring and performance measurement—often have the strongest foundation for long-term success. 

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

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

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

For states considering similar approaches, transparency and provider engagement are essential. Providers need to understand the objective is improving quality and protecting access—not simply limiting participation. 

States and payers should be focusing on metrics that matter—reductions 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. 

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

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

Advanced analytics can help states and health plans identify unusual utilization patterns, monitor 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. 

At the same time, technology can become a hindrance when it generates duplicative reporting requirements, repeated manual submissions, or additional 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 remain small practices with limited infrastructure and resources. 

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—not increasing—administrative burden. 

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

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. 

HMA, including HMA companies Wakely and Leavitt Partners, is actively helping states, health plans, providers, and other stakeholders navigate the changing landscape of behavioral health delivery. HMA can support strategic planning, policy design, value-based payment design and readiness, data development and reporting. Connect with HMA to learn how we can support your organization in navigating the next phase of behavioral health transformation and care delivery. 

You can listen to the full discussion with Alyssa Lord on HMA’s Vital Viewpoints podcast, Can Better Program Integrity Lead to Better Behavioral Health? Access additional insights from HMA’s behavioral health team here