The State of Provider-Led Communities in Behavioral Health.

One continuous, provider-branded circle.

Active clients, whose membership begins the day they commit to treatment; alumni, whose membership never expires; and the families and support systems beside both. Across substance use, mental health, and co-occurring programs. The study probes the three gaps a community must close: the in-treatment gap (Ch. 4, between-session visibility and evidence), the alumni gap (Ch. 2–3, the decay curve and referral economics), and the family gap (Ch. 1, the strongest-evidenced lever in the field, and the least deployed).

Everyone has a program. Almost nobody owns one.

88% of organizations run or plan an alumni and community program, which makes it one of the most universal commitments in behavioral health. Then the follow-through thins out: fewer than one in four gives the program dedicated staff, and half still run community on a consumer social platform never built for recovery.

Only 21% run structured family programming, making the strongest-evidenced engagement lever in behavioral health — family training engages treatment-refusing individuals at five times the rate of standard referrals in randomized trials — the least deployed part of the community.

The decay curve, measured for the first time.

We asked every organization the same four questions: of clients discharged 30, 90, 180, and 365 days ago, what share could your team actually reach today? The median answer traces the curve below. The second finding hides in the non-answers: at every horizon, roughly a fifth of the industry does not track this at all.

The cheapest admissions, mostly unclaimed.

Alumni referrals are the closest thing this industry has to free admissions, and best-practice programs run them at 25 to 30% of census. The benchmark shows how far the field sits from that mark, and how few would even see the signal: nearly half would not know if an alumnus had referred someone in the last 30 days.

For a 300-discharge organization, closing the gap from the 5–14% median band to the 25% benchmark is worth roughly 45 additional admissions a year. At typical commercial episode values, that is a seven-figure line item acquired at close to zero marketing cost.

Payers ask for proof at two moments. The field is short at both.

While care is being authorized, and after it ends. Between sessions, most organizations see little; after discharge, nearly half collect nothing structured at all. The cost shows up as lost authorized days, and it showed up for most respondents inside a single quarter.

Interested, and unequipped.

Value-based behavioral health is no longer hypothetical; federal models now tie payment to measured outcomes and national payers are scaling value-based networks. The provider side of that handshake is willing but not yet able: interest in outcomes-based arrangements runs seven times ahead of participation.

The most-wanted payer capability is payment for post-discharge engagement, at 50%, ahead of faster authorizations. Providers are asking payers to fund exactly the period where their own visibility is weakest.

The gap is not budget or luck. It is structure.

We ranked organizations on a composite of 90-day reachability and alumni referral share, then compared the top 25 with everyone else. Someone owns the program, the motion is systematic, and measurement exists. Notably, 40% of the top quartile clears the 25% referral benchmark, against 8% of the rest.

Reviewed before we field, published whatever the data says.

This edition is a simulated preview. Every figure on this page is generated from a synthetic dataset of 100 respondents, constructed to demonstrate the report's design, question structure, and analytical cuts ahead of live fielding. Distributions are seeded from published industry anchors where they exist and from conservative assumptions where they do not. No real survey responses are represented.

The live 2026 edition follows this method: a twelve-minute structured instrument fielded to senior operators (CEO, COO, clinical and alumni leadership) of US substance use and mental health provider organizations; one response per organization, deduplicated by domain; speeders and straight-line responses excluded; aggregate-only reporting with a minimum cell size of five; methodology and question wording published in full; external reviewers invited to critique the method before fielding, with their notes printed regardless of favorability.

Simulated sample frame: 52% founder or family owned, 30% private equity backed, 11% nonprofit; levels of care spanning detox through outpatient; single-site through 25+ location operators.