When Delays Become Risks: How Care Gaps Derail Treatment & What MCOs Can Do About It

Care gaps cause unnecessary health risks and higher costs.

For health plans, few challenges are as persistent or as costly as the revolving door of behavioral health and substance use relapse. To illustrate how this plays out in real life, let me tell you about Ben. His story shows how avoidable gaps, delays, and administrative barriers create unnecessary risk, higher utilization, and poor outcomes that health plans ultimately carry.

A Common Story That’s Preventable 

Ben, 21, has struggled with alcohol misuse and bipolar illness since adolescence. He has encountered multiple systemic roadblocks that have derailed his treatment. His ER visits, detoxes and relapses were each followed by:

• Delayed or missing referrals

• Long wait times for next level of care

• Inappropriate placements 

• Last minute program admission cancellations

Ben entered detox and agreed to an Intensive Outpatient Program (IOP). The day he was scheduled to start, it was cancelled because of an insurance-driven intake with minimal time slots that he couldn’t overcome. Ben relapsed four weeks later. He was hospitalized and placed on a geriatric psychiatric ward, then discharged home with:

• No care plan

• No placement or consideration of his dual-diagnosis needs

• No medication-assisted treatment (MAT)

Ben relapsed again while waiting another week to start a rehab program that his family found for him. He completed a 30-day program and couch-surfed for another 10 days, an especially high-risk period, before entering a recovery home.  

How Compris Helps Managed Care Organizations (MCO) Close the Gaps

Members like Ben fall through the cracks because the system leaves gaps they cannot bridge alone. If Ben had taken Compris after detox or upon hospital discharge, he would have gotten a care plan to remedy these gaps by

• Addressing his immediate needs, including housing

• Providing timely level of care placement, MAT, and co-occurring considerations

• Supporting reachable and sustainable recovery with a shared care plan

• Monitoring progress with Interval assessments that guide care decisions across clinics and networks

For MCOs, this means 

• Fewer avoidable ER visits

• Lower inpatient costs

• Better early intervention

• Higher member success and satisfaction

Where the System Failed and Why It Matters to MCOs

Ben’s experience is not unusual. Across behavioral health and addiction treatment, members often

• Experience long delays from days to weeks between levels of care

• Lose motivation during wait times missing critical windows for engagement

• Get inconsistent care coordination and assessments across providers and settings

• Lack visibility into next steps and available resources

Proactive Care Coordination: An Opportunity for MCOs to Improve Outcomes and Reduce Costs 

Ben’s story illustrates how delays and administrative barriers in behavioral health care can escalate risk, increase costs, and compromise outcomes. For MCOs, closing these gaps is imperative for clinical, financial and operational reasons. 

By leveraging tools like Compris, health plans can ensure members receive timely, targeted, coordinated, and sustainable care. 

The opportunity is clear: MCOs that proactively bridge these gaps, can improve engagement, reduce costs, and strengthen outcomes for members and the healthcare systems.

Learn how Compris can help your organization identify and close care gaps before members fall through the cracks.

Read our white paper or schedule a demo.