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When health plans evaluate new behavioral health partners, the central question is straightforward: Does this improve outcomes in a way that meaningfully changes total cost of care? In our recent webinar, we examined that question through the lens of obsessive-compulsive disorder (OCD), pairing clinical insight with longitudinal claims data to understand what happens when members receive specialized, evidence-based treatment for OCD.
The results offer a clear view into how specialized OCD treatment affects utilization, pharmacy spend, and total cost of care.
Dr. Jamie Feusner, Chief Medical Officer at NOCD, began with the clinical foundation. OCD affects roughly one in fifty people over a lifetime and often begins in childhood. It is frequently misunderstood and commonly misdiagnosed, with many individuals waiting a decade or more before receiving effective care.
NOCD was built around exposure and response prevention, or ERP, a first-line cognitive behavioral therapy for OCD. The structure of the model was intentional from the beginning. Rather than spreading sessions evenly across months, the team designed a more intensive early phase of care.
“We asked ourselves, how can we get people better faster?” Dr. Feusner shared. “There’s a limited supply of trained therapists, everyone’s time is valuable, and healthcare costs can be high. So how do we make the best use of therapist time and patients’ time?”
The answer was to concentrate visits at the outset. By increasing session frequency early, members can learn and practice exposures without long gaps that erode progress. “If you have a lot of time between sessions, it’s very hard for people to learn it well and get going,” he explained. Momentum matters in OCD treatment. When members are able to practice skills repeatedly and receive feedback in close succession, they begin internalizing the work rather than depending on the therapist to drive it.
This design reflects a simple hypothesis: structured, time-limited, high-fidelity treatment can reduce long-term burden on both patients and the system.
The question for payers was whether that hypothesis would hold up under rigorous claims analysis.
Aaron Jurgaitis, an actuary at Optum, walked through the study design. Using one of the largest longitudinal commercial claims datasets available, the team compared members treated by NOCD to matched individuals with OCD who received treatment as usual.
Because randomized trials are rarely feasible at scale in this context, the team used two complementary methods:
This approach allowed the team to isolate the financial impact of NOCD’s intervention while accounting for underlying risk and utilization patterns.
The sample included over 400 members in the NOCD cohort matched to approximately 2,000 controls. The result was a robust dataset capable of producing statistically reliable conclusions.
On average, members treated by NOCD generated approximately $3,400 in savings per member per year compared to matched controls.
What drove that difference?
Several themes emerged:
The severity analysis is especially relevant for health plans. Savings were observed across mild, moderate, and severe cohorts, but the magnitude scaled with acuity. Members in the severe category saw savings exceeding $10,000 per year, largely due to avoided hospitalizations and residential treatment.
Pharmacy spend was a consistent contributor to savings across the spectrum. ERP can reduce the need for medication initiation, dose escalation, or augmentation strategies. In some cases, improved symptom control may allow for careful tapering under medical supervision. Each of these scenarios has cost implications.
Perhaps most compelling was the reduction in non-behavioral medical spend. Members with untreated or undertreated OCD often carry significant comorbidity, including depression, eating disorders, substance use disorders, and chronic medical conditions. When behavioral health improves, engagement with broader medical care often stabilizes as well.
Jurgaitis emphasized that the data ultimately reflect real lives, not just financial trends. “When someone is suffering from a behavioral health condition, everything else tends to suffer too,” he explained. “If we manage the whole person, including their mind, we start to see favorable impacts across the board.”
OCD is frequently managed in general outpatient settings where symptom severity is not routinely measured, and ERP expertise may be limited. The average delay to accurate diagnosis and effective treatment remains unacceptably long.
From a plan perspective, that delay has consequences:
Specialized digital delivery models expand geographic access, particularly in rural areas where ERP-trained clinicians are scarce. For members who might otherwise cycle through fragmented care, access to structured, measurement-informed treatment can interrupt that pattern.
For actuaries and clinical leaders alike, this study reinforces several practical considerations:
As Jurgaitis pointed out, OCD may represent a smaller prevalence population compared to diabetes or congestive heart failure, but for affected members, it is life-defining. Even within a more concentrated population, the cost differentials were meaningful.
For health plans committed to expanding access to high-quality care, the takeaway is clear. Investing in condition-specific, evidence-based behavioral health treatment is a strategic decision that aligns improved member experience with measurable cost performance.
For a deeper look at the claims methodology and detailed results, review the full study. And if you’d like to hear the conversation behind the data, the webinar recording is available on demand.
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