The INVEST Conference is an annual event that brings together behavioral health practice operators and investors funding the industry’s growth. This year’s gathering, hosted by Behavioral Health Business, revealed shifts in what both groups are prioritizing.
The headline conversations centered on M&A activity, emerging treatment modalities, and technology adoption. But the real story was more nuanced: investors and operators alike are moving past simple growth metrics. They’re asking harder questions about what makes a behavioral health practice truly valuable, and the answer kept coming back to operational excellence..
The most effective practices aren’t just growing fast or raising capital. They’re executing well across their entire business—delivering innovative treatments, improved outcomes, mastering their revenue cycles, leveraging technology strategically, and building partnerships that create lasting competitive advantages.
We spent two days listening to industry leaders, private equity investors, and successful practice operators discuss what’s working. Here’s what we heard, what it means, and how forward-thinking practices can position themselves for sustainable growth in 2026 and beyond.
Setting the Stage: The Behavioral Health Market is Finding its Footing
Dexter Braff of The Braff Group kicked off the conference with a candid assessment. The M&A market recorded 155 combined transactions in 2024, representing a recovery from recent lows. His grade for the current market? “A B or a B-minus.” Not spectacular, but showing momentum.
Q1 2025 deal activity jumped 35%, suggesting that capital is moving again. Yet Braff’s measured optimism reflected what many operators already know: access to capital matters far less than what you do with it. The practices attracting serious investment attention aren’t just pitching growth stories. They’re demonstrating operational discipline, clinical innovation, and the ability to navigate increasingly complex reimbursement dynamics.
This context shapes how we should think about the five strategic themes that dominated the event.
1. Technology Amplifies Excellence (It Doesn’t Create It)
“It’s completely over-hyped. And there is also real value in some places. Both can be true.”
Chris Ivany, CEO, Family Care Center
This perspective on artificial intelligence and automation in behavioral health is an important one. The practices seeing genuine ROI from technology investments are those deploying purpose-built tools strategically to amplify what well-trained staff and good processes can accomplish.
Research professor and leadership expert Brené Brown has been speaking extensively about this exact paradox related to AI in the workforce. Leaders can choose to be on “team technology” or “team human,” but “the future will belong to those of us who can straddle the paradox of humanity and technology.” She emphasizes that paradoxical thinking is essential as roughly 78% of enterprise companies currently deploy AI, yet success requires figuring out how to unite technology with human capabilities rather than picking sides.
Brown notes that leaders must hold multiple truths at once: “We have to be daring, but we have to be incredibly grounded. We have to be very creative and super disciplined. We have to love our technology and make sure there are humans in the loop.”
This mindset aligns with what we’re building at ProsperityEHR. We won’t overpromise what AI can do and underdeliver real solutions. Technology should make the hard work of running a behavioral health practice more manageable rather than adding complexity or replacing the human judgment that makes excellent care possible.
The data shared throughout the INVEST conference told a story of measured progress. For example, up to 70% of visit documentation at some practices now gets completed by AI scribes. Automation can now handle portions of eligibility verification and prior authorization workflows. These aren’t trivial improvements. They’re a big deal because they free up providers and support staff to focus on clinical work and reduce the administrative burden that otherwise burns out talented staff.
In a case study presentation about JourneyPure’s accounts receivable (A/R), Dr. Brian Wind cited a $14.52 million improvement after implementing AI-enhanced workflows. But he also made it candidly clear that not all of it could be attributed to technology alone. Pragmatism matters here because while good technology provides leverage, it doesn’t replace solid processes, compliance discipline, or relationship-building.
This is especially true in revenue cycle management. During another panel on A/R and denial management, experts emphasized that AI cannot yet handle the full complexity of these workflows. What commonly helps keep mental and behavioral practices “out of the red” is what’s known as a “golden biller.” This is someone with deep institutional knowledge about getting claims paid. These people are rare to come by and hard to replace.
The technology opportunity isn’t replacing that expertise. It’s codifying it, making specialized knowledge more accessible across the team, and building systems that don’t collapse when key people leave.
2. Diversification Plus Data Equals Leverage
Think of treatment modality expansion like assembling a fully equipped toolkit instead of relying on a single hammer. The more tools you have, the more problems you can solve. But here’s the catch: those tools only create value if you actually know how to use them and can prove they work.
“Review all avenues for growth by adding modalities. Do it organically though. Don’t rely on M&A to solve all of your problems.”
Chris Ivany, CEO, Family Care Center
Many practices chase acquisition-driven growth as a shortcut, only to discover they’ve layered complexity onto operational weaknesses. The more effective path is build modality expansion into their infrastructure before attempting to scale. This means training your current clinical team on new evidence-based treatments, implementing outcome tracking for each new modality, and making sure that your operational systems can handle the added complexity. Start with one new service line, prove that it works both clinically and financially, and then add another one. If and when you do pursue M&A, you’ll be acquiring from a position of operational strength rather than trying to fix fundamental problems through acquisition.
The most attractive practices to both payers and investors are those offering evidence-based interventions beyond traditional talk therapy and medication management. Transcranial Magnetic Stimulation (TMS), esketamine, ketamine therapy, and medication-assisted treatment (MAT) aren’t fringe therapies. They represent the future of outpatient care because they address a fundamental problem: traditional approaches don’t work for everyone, and high-acuity crisis intervention is expensive for everyone involved.
But data becomes critical here. Ivany emphasized that being data-driven gives practices actual leverage with payers. If you can demonstrate outcomes, you can make a compelling case for better reimbursement rates. This includes clinical outcomes, yes, but also data on your hiring practices, training protocols, and quality assurance processes.
Now consider what this means practically. A third of Americans still live in mental health professional shortage areas. If you can show payers that you not only deliver good outcomes, but that you’ve also built systems to recruit and retain quality clinicians in challenging markets, you’re offering something scarce and valuable.
3. Interventional Psychiatry Moves from Niche to Mainstream
“Interventional psychiatry is the future.”
Dr. Eugene Lipov, Stella Mental Health
This prediction appears to be based on real evidence and economics. During panels focused on emerging therapies and investment opportunities, Dr. Lipov outlined two criteria for evaluating new treatment modalities: effectiveness backed by evidence, and accessibility for patients who need it. By these measures, interventional psychiatry is rapidly proving itself.
Spravato, Johnson & Johnson’s FDA-approved esketamine nasal spray, is tracking toward $1 billion in annual sales, growing approximately 56% year-over-year. Forget a small pilot program; this shows market validation for novel approaches to treatment-resistant depression and acute suicidal ideation.
What’s particularly interesting is the payer enthusiasm. Why would insurers, typically conservative about new treatments, show considerable interest in interventional psychiatry? Because the math works. Patients who respond to these therapies often achieve better outcomes faster, require shorter treatment durations, and most importantly, stay out of expensive inpatient settings. The long-term cost savings are becoming undeniable.
The U.S. behavioral health market is projected to grow from approximately $92 billion in 2024 to $151.6 billion by 2034. A meaningful portion of this growth will come from treatment modalities that barely existed a decade ago.
Speakers also highlighted emerging compounds like ibogaine, which showed incredible results in trials. The broader category of psychedelic-assisted therapy is moving from fringe to mainstream clinical consideration, though quality clinical oversight remains essential.
Despite the rise of ketamine clinics in the U.S., few psychiatrist-led entities successfully offer comprehensive solutions to patients and families. This gap presents both a quality concern as well as an opportunity. Practices that can deliver interventional psychiatry with appropriate clinical infrastructure, outcome tracking, and integrated care planning will differentiate themselves in an increasingly crowded field.
These interventions can be further optimized with smart technology too. Think: automated check-ins between sessions with escalation pathways to clinical staff when patient responses indicate distress. This hybrid approach maximizes expensive clinical time while maintaining care continuity
4. Revenue Cycle Excellence Is No Longer Optional
If there was a thread of concern running through sessions on financial sustainability and practice turnarounds, it centered on reimbursement. We heard many times that reimbursement rates haven’t kept pace with operational costs, and this compression is forcing practices to get their financial operations right or risk failure.
The numbers tell the story. Many practices now achieve only 83-85% net collection rates. Just a few years ago, 90%+ net collection rates were middle-of-the-pack performance. Today, they’re among the best. Median hospital operating margins remain below 3%, with 40% of hospitals reporting negative margins in the first quarter of 2025.
According to a 2024 poll from the Medical Group Management Association, 60% of providers reported that insurance denial rates rose that year. The administrative cost is substantial as managing denials can cost healthcare organizations upwards of $7.2 billion annually.
Here’s the critical insight from denial management discussions: denials are almost always a front-end problem. Nearly half (49.7%) of all claim denials stem from front-end errors such as inaccurate client details or insurance verification issues. This matters because it means the solution isn’t working harder on the back end to fight denials. It’s building better processes on the front end to prevent them.
During a panel on navigating turnarounds and distressed practices, speakers noted that organizations wanting to survive, let alone grow, need to execute well across all operational areas. RCM issues develop slowly over time but often take longer to fix than practices have runway available.
Forward-thinking practices are implementing payer-specific workflows in their EHR systems, creating custom rules that automatically update charges and claims when requirements change. They’re standardizing documentation templates reduce denials and avoid audits. They’re using predictive analytics to identify which claims face the highest rejection risk, allowing proactive intervention.
When acquirers evaluate potential partners, every single one of these things matters:
- leadership quality
- service offerings, particularly interventional psychiatry capabilities
- competitive reimbursement rates
- regulatory compliance
Note that lapses in compliance will derail transactions that otherwise make financial sense. The due diligence process now scrutinizes compliance infrastructure as carefully as financial performance, recognizing that regulatory failures create existential risk regardless of how attractive the growth story might be.
Medicaid funding has also added another layer of complexity. Multiple speakers acknowledged this uncertainty will likely cloud the market for the next couple of years, making conservative financial management and payer diversification even more critical.
Theme 5: Integration and Collaboration Build Competitive Moats
Scale alone doesn’t create a sustainable competitive advantage. Throughout discussions on health system partnerships and value-based care, speakers highlighted that real differentiation comes from building trusted, interoperable relationships with health systems and payers, not simply from getting bigger through acquisitions.
What Bidirectional Interoperability Actually Means
Most behavioral health providers focus on one direction: receiving referrals from health systems. But true interoperability is bidirectional, and it starts before the patient ever walks through your door – or at least it should. Here’s what this looks like in practice.
Inbound (before the first visit)
When a health system sends a referral, bidirectional interoperability means you’re also receiving critical clinical context directly from their EHR. Instead of starting from scratch, you have access to the patient’s medical history, current medications, recent lab results, and the specific concerns that prompted the referral. This means your clinicians can prepare for the appointment, identify potential contraindications, and begin forming a treatment approach before meeting the patient. It also reduces the administrative burden on your front desk staff, who no longer need to chase down records or ask patients to fill out lengthy intake forms with information that already exists elsewhere.
Outbound (closing the loop)
After the patient’s first appointment, that bidirectional flow continues. Your EHR automatically sends visit summaries, assessment results, and treatment plans back to the referring provider. They can see that their patient kept the appointment, what the initial assessment revealed, and how treatment is progressing. When your patient has a follow-up with their PCP, that doctor can see recent PHQ-9 scores, medication changes, and therapy progress. No additional phone calls (or faxes) needed.
This creates a closed loop that benefits everyone. The referring provider gains confidence that their referrals are being handled well. Your practice becomes an extension of their care team rather than a black box where patient information disappears. And patients receive more coordinated care because their providers communicate effectively.
The technical implementation might involve direct EHR integrations, health information exchanges (HIEs), or standardized data feeds using FHIR protocols. But the strategic value is what matters: you become indispensable to your referral partners because you’ve embedded yourself in their workflow and demonstrated that you’re a reliable collaborator in patient care.
“Because we have developed relationships and reputations with the providers for high quality, multi-modality care.”
Chris Ivany, CEO, Family Care Center (on why health systems choose to refer to his organization)
This relational capital, built over time through demonstrated clinical excellence and reliable communication, creates switching costs that can’t be easily replicated.
This integration strategy has practical applications for payer relationships too. One lesson shared by Charlie Health: building relationships with local Blue Cross Blue Shield payers created a template for establishing contracts with other BCBS entities nationwide. Start local, prove value, then scale systematically rather than pursuing scattered approaches to payer contracting.
Industry experts noted that consolidation can be beneficial in clarifying who’s driving quality and outcomes in a market that has seen considerable fragmentation. But consolidation for its own sake, growth without the operational discipline and relationship infrastructure to support it, leads to mediocrity.
The transition to value-based contracting, while still on the horizon and met with some skepticism, represents the logical endpoint of this trajectory. When behavioral health providers can demonstrate not just activity metrics but genuine outcome improvements and cost savings, they position themselves as strategic partners rather than cost centers in the healthcare ecosystem.
What This Means for Your Practice in 2026
The practices that will thrive aren’t those chasing the latest trend or hoping technology alone will solve structural problems. They’re the organizations executing across all aspects of the business while also providing quality care.
This is what we call operational excellence. Achieving this requires:
- diversifying treatment modalities while building analytics capabilities
- deploying technology strategically and installing it optimally
- incorporating emerging therapies with appropriate clinical oversight
- mastering revenue cycle management as a core competency
- building deep, collaborative relationships with health system and payer partners
- It’s a hefty checklist, but you don’t have to be perfect at all five themes immediately. Your behavioral health practice does, however, need to be intentional about building capability in each area, measuring progress, and improving systematically.
At ProsperityEHR, we’re focused on helping practices navigate exactly this challenge in 2026 and beyond. Our approach is different than most EHR vendors. We know that software alone doens’t create operational excellence. Real transformation requires the right technology, the right processes, and the right people equipped with the knowledge to deploy it effectively.
That’s what sets us apart. Beyond delivering the technology, we are an implementation and support partner with a proven growth model for mental and behavioral health practices. We help align your workflows, train your team, and build the operational infrastructure that makes sustainable growth possible. We also implement the processes that prevent denials before they happen, track the outcomes that matter to payers, and create the integrations that make you an invaluable partner to health systems.
The practices that will become industry leaders in behavioral health won’t be waiting for perfect conditions. They’re already focused on building operational excellence one strategic decision at a time. We’re here to help you realize your mission. Connect with our team to discuss what this looks like for your practice.