What "Right Level of Care" Actually Means — and Why It's Not About Limiting Access

Mental health benefits have a utilization problem, but not the one most people assume.

The standard complaint is that too few employees use mental health benefits. Low utilization looks like failure, so the instinct is to optimize for the opposite: more sessions, easier access, fewer barriers. Some employers now offer unlimited therapy as a selling point.

The problem is that high utilization and good outcomes are not the same thing. A member who attends 40 therapy sessions without improving has high utilization. A member who works with a coach for six sessions, builds the skills they came for, and doesn't need further care has low utilization. The benefit that looks better on a utilization report is not the one that helped someone.

The real question is never how much care a member received. It's whether they got the right kind.

What "right level of care" means in practice

Right-level-care routing is a clinical decision, not an administrative one. It starts at intake: a member's presenting concerns, symptom severity, and functional context inform where they belong in the care system. Coaching is appropriate for a wide range of presentations, including members with moderate to severe symptoms, because the mechanism-targeted work coaches do can produce meaningful clinical outcomes across the severity spectrum. That's documented in our published research (Pickover & Adler, JMIR Formative Research, 2025) and in our ongoing internal measurement.

But coaching is not appropriate for everyone. A member who presents with active psychosis, severe eating disorder, or a level of symptom severity that exceeds coaching scope gets navigated toward clinical care, not enrolled in a coaching caseload. That decision happens at the front door, not after six sessions of unsuccessfully trying to make coaching work.

The same logic applies in the other direction. A member who has been in therapy for years managing a presentation that coaching could address well is not well-served by more therapy. They may be better served by a different kind of relationship with a different set of tools. Right-level routing isn't about substituting cheaper care. It's about accurate triage.

What measurement-based care adds to the picture

Getting the initial placement right matters. So does what happens after.

Wave tracks clinical outcomes throughout the engagement using the DASS-21, a validated measure of depression, anxiety, and stress, administered every 30 days. That cadence exists because right-level placement at intake can be wrong, and the data should surface that quickly. A member whose symptoms are not improving after a month of coaching has generated a signal that something needs to change: the coaching approach, the focus, or the level of care.

This is what makes Wave's model different from both traditional EAP and most digital mental health platforms. EAP models typically offer a fixed number of sessions, after which the member is on their own, without measurement of whether those sessions produced any clinical benefit. Many digital platforms measure engagement metrics (logins, session completions, content opens) rather than clinical outcomes. Engagement metrics tell you whether members are using the product. They say nothing about whether members are getting better.

Across Wave's member population, 72% of engaged members experience clinically meaningful symptom improvement within eight weeks. That figure comes from internal book-of-business data and is distinct from our peer-reviewed published outcomes. The peer-reviewed cohort (n=64, Pickover & Adler, 2025) found significant reductions in depression, anxiety, and stress, with over half of participants presenting at severe to extremely severe symptom levels at intake. The outcomes held across the severity spectrum, including the members most plans expect to need higher-cost clinical care.

Why health plans should care about the distinction

Health plans pay for utilization. They buy sessions, or they buy covered lives, and the assumption built into most contracts is that more care is better. That assumption is increasingly hard to defend when outcomes data is available.

A care model designed around right-level routing produces a different utilization pattern than one designed around maximizing engagement. Members who improve in coaching don't need to escalate to therapy. Members who were never coaching-appropriate get routed to clinical care faster, without the delay of a coaching engagement that wasn't going to work. The total cost of care goes down not because access is restricted, but because the routing is accurate.

This is also an equity argument. The populations most likely to be undertreated or misrouted in traditional mental health systems are the same populations that benefit most from accurate triage: members who can't access therapy due to waitlists or cost, members for whom a therapy-first model never fit, members with moderate to severe symptoms who have been told that coaching isn't for them. Wave's published data shows meaningful outcomes for racial and ethnic minority members and low-income members at rates that exceed what traditional therapy typically produces for these populations. Accurate routing is part of why.

What to ask about any mental health program

If you're a health plan or employer evaluating mental health benefits, the questions worth asking are not primarily about utilization:

• What does the program measure? If the answer is session completions or app opens, you're looking at engagement data, not outcomes data. They're not the same thing.

• How does the program decide where a member belongs? If the answer is "members self-select the service," the routing is not clinical. It's whatever the member chose on a dropdown.

• What happens when a member isn't improving? If the answer is more of the same, the model has no feedback loop.

Right-level care is not a marketing frame. It's a clinical design principle. The difference shows up in the outcomes data, and increasingly, in what health plans are requiring before they sign.

Wave's outcomes methodology and published research are described in our Auditable Outcomes cornerstone. Our peer-reviewed study is published in JMIR Formative Research (Pickover & Adler, 2025). Health plan and employer partners can reach us at partners@wavelife.io.