Building Collective Power with Nicole Sartini

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies and all the folks in between. Let's explore what's working, what's not, and what's next.

Hello everyone. Today I'm so excited to bring you this conversation with Nicole Sartini of the Mental Health Insurance Reform Task Force. Some of the things we touched on were ways that advocacy is happening. Nicole definitely used some terminology that you may or may not be familiar with, but don't worry, we've got resources in the show notes and you can definitely dive in a little bit more. She has a system called the Progressive Advocacy Ladder and looking at where different states are, what's happening in different states, and that is all on the website. So as you dive into this conversation, I just want to highlight the fact that what Nicole is working on and all of the grassroots volunteers, she was very clear this is not just her thing. Is there really a way for there to be collective advocacy in the mental health field right now to so check it out. I'm excited for you to hear from Nicole herself and to see the resources she is providing. Welcome back to the Mental Health Evolution Podcast. I'm Rachel Harrison and today I'm speaking with Nicole Sartini, a licensed clinician, group practice owner and founder of Build Better Health, which is a nonprofit think tank that is building the kind of collective power that this field has been missing. Build Better Health advances two initiatives. The first is the Mental Health Insurance Reform Task Force, a provider led coalition now active in all 50 states that gives clinicians a practical step by step path from documenting payer harm all the way to enforcement and fair reimbursement. The second is the People's Solidarity Fund Healthcare Cooperative, which is a pilot launching in 2027 that is designed to reduce provider and patient reliance on insurance companies altogether. We have had a number of conversations on this podcast about understanding the problems going into our field. But this episode is about some possible solutions and that is really exciting. Before we dive in at the end of today's episode, we're going to share a few articles and resources for anyone who wants to go deeper. We will link everything in our show notes and newsletter. Nicole, welcome to the show.

Thank you so much for having me and thank you for what you're doing to help put the Word out on ways that we can help evolve our field.

Yes. Awesome. Thank you. So I'm curious, how did you get to this place of wanting to do more organization and advocacy for providers in our field? What kind of led you there?

Well, I am a long term provider. I've been in the field technically since I was 19 years old, but not as professional yet. And professional therapists for a very long time worked all sorts of positions, both community based and eventually did private practice and started a group practice. Like you have multiple locations and we have 60 providers. And it was just like 2024 when we started to really feel some shifts happening within the insurance industry and in our ability to pay our clinicians fairly. And we ended up seeing, because of carve outs and repapering of various contracts, a drop of about 30% of our income for the same exact number of sessions. And as you can imagine, a practice that, you know, does its best to treat the clinicians and providers that are there to do good work in the community. We really prided ourselves on having a great place for these people to work. But we ended up, for the first time, after being in practice for 10 years, having some turnover to people who ended up going to platforms because they didn't want to do the entrance model that we did anymore. And it was very loving and very sad to lose everybody. We didn't think that would happen, but we understood that clinicians had to do what they needed to do. But it started to get me concerned about the direction that things were moving. And so I ended up starting here in Kentucky with a little bit of local organizing. And at first I thought like, what we could do was different than what ended up being achievable. In fact, I didn't even know that there were actually laws already in place that were supposed to be protecting us from some of the stuff that was happening. And when I learned that I started to gather people and we started doing these monthly meetings, we did a survey and it started in Kentucky. We were doing these all across Kentucky, but more states started to learn about what was happening, what we were doing, and asked to come in and be involved. And within this two year period, we've actually grown to have 50 states participating. We have 4,4000 providers directly participating and then more of course, who are attached to them and learning about the work that we were doing. So we didn't expect it to happen. It was a true grassroots movement that we started. And I say we because of course at this point it's very much a we thing, not a Me thing. And that's part of what's so important to the mission is like putting the power back into the hands of the people instead of just a select few, which is what we're seeing happen with these insurance companies and these platforms that are coming in and taking over the industry, it seems, or trying to.

Yeah, that's great context to be able to understand. So tell me a little bit more about exactly what you're doing, what's happening with both of your organizations and how do they function?

Okay, so with the mental health insurance reform task force we now have, we have a brand new website that has state specific pages. So we have state leads in each state who now manage those and can help organize local stuff using our shared resources and our shared learning to help advocate for specifics within their state. And of course we have the national gatherings as well so we can learn from each other. What we did was we created a system to track where each state was like a rung system and one's not necessarily better than the other. A lot of states skip rungs and have to go. You know, it's not always in order, but it does give us a little bit of a clue about which states are working on similar things. So a state doesn't have any clawback protections or not adequate clawback protections and needs more. Those states are on the same rung and can learn from and with each other. So we have committees where there's shared learning that can occur. So the three subcommittees that we have are the Education committee. So that's. Those are people who are putting together materials that are going to go to legislators or to providers or sometimes to employers or to consumers or patients. And then we have the Innovation committee and we're thinking there through terms that are outside the box. How can we become less reliant on insurance in the first place? How can we build around it and pull power back into the hands of. And again we save into the hands of the people. And we really mean that not just providers. We want mutually respectful systems that are going to honor clients access and ability to gain affordable quality care. And so we try to think through things that are innovative and new and that's. We'll talk about PSF in a little bit, I'm sure. And that's where that kind of branched out of. And then we have the legal and legislative committee and there we work specifically on creating model legislation based on successful legislation in various states on the topics within that advocacy ladder that we've created in the rung system that we created that help states use things that we've created to advocate for that change within their own state legislation. And we also, of course, look at litigation and we have about five attorneys that we consult with. One's a paid attorney, the others are just advisors. And we're tracking and collecting data so that if and when the time comes, we can take action that way as well.

Wow. I love it. Yeah. We've had several attorneys on the podcast talking about things, especially parity. That seems to be something where there's a lot of laws on the books

already and that's both at the federal and the state level. And like I said about in Kentucky, I was so surprised. I thought when this legislator said, yes, I'll help you get this going. And I was so excited. But I was looking at, when she sent it to me, I was like, but this is already in here. Like, this is just. I couldn't believe that what was on paper, it just didn't have the teeth to be enforced. And that's kind of what we've seen with the, I mean, the PIA. That original law was 2008. Right. And it's had many reiterations and changes over time. That's the federal law. And you know, 2022 is when they started to do those reviews and they started to check and see if it's actually being followed. And over and over I think there's been about 4 cents and none of them have have shown that insurers are compliant because what happens is it is cheaper to be non compliant and give a report that is demonstrating your non compliance than it is to actually be compliant because there's no consequences. And so there are some federal laws that are being proposed right now and that we support. We have a federal policy team who's following those things closely. And patients Over Profit is one of an example of one of those. But there's other things that are happening. But as it stands right now, as you've probably heard, the latest thing that was supposed to add more teeth, the final rule which happened in 2024 was paused. And it's so wild because we were literally the day that happened, we were presenting, doing one of our provider roundtables here in Kentucky and we had to change the slides. But what people, what's important for people to understand is just because the latest thing was paused, the latest addition to that law was paused, that doesn't mean that everything that was there before isn't still the law. It actually is. And so we really would love to see more enforcement at the Federal level, because as you probably know. But maybe the listeners don't. About 60%. There's a. It's a range and depends on the state. Lots of our insurance plans and coverage is overseen by the federal government, whereas some of it is overseen by state governments. So even when we have really big wins like we had with Illinois with HB 1085, that connected the reimbursement floor to the Medicare rate, even when that happened, it's going to affect millions of people. It's going to. It's huge. It's such a great win. And also it doesn't necessarily relate to all the insurance plans because some of those are overseen by erisa, which is the federal law.

I say, yeah, it is a really complex system.

It is. But I think it's important that people know that when things are paused like that federally, it actually is a really good time for states to take action. And there are several states who are quite close to being able to pass something similar to HB 1085. And if they do that, that has an influence on everybody else. That changes the scene a little bit. And what seemed like it was impossible is now showing be possible. When I first started advocacy, I was an advocate my whole life. Okay, lots of things. But for this particular thing, when I first went and made and made an appointment with the Department of Insurance and we had a. And they basically like. They acted like it was nothing that could ever happen or would happen. And now that Illinois has done what Illinois has done, we can take that in and we can use that as part of our advocacy and we can track now better what steps we might have to take before we get to the spot where we can connect it to a reimbursement floor. In the case of Illinois, they raised the provider's rates by about 30% for commercial insurance. And it really did affect a lot of people. And it means that people are going to stay in network with insurance companies, which is important.

Right.

Because if they're not in network, people who need to use their insurance aren't able to do it. And the insurance companies can say that they have network adequacy or that they offer something on paper, but in reality, if the clinicians aren't. Aren't able to take it because it's not sustainable, then they actually don't really have it. And that's when you said the word parity. You know, we're talking about parity. It's actually the law says that we behavioral healthcare should be accessible. The network adequacy should be Just as high for behavioral health as it is for physical health. But clearly that's not the case.

Right, right. And it is known problem. You know, I think about as you're talking about this, if our listeners are thinking, okay, so I get this a little bit, but why should I care? How would you answer that question? Like what's really the why? What kind of differences can these things make in people's lives, either in the industry or just people who are seeking mental health care?

Yes. Okay, so to answer this question, I think it's important that we kind of broaden out it from just the parity discussion because of course it matters that providers are paid adequately so they'll stay in network and so clients can have people to see them in network and access quality care. But there's also the second pillar that we organize around, which is vertical consolidation. And that is mattering for a whole nother set of reasons that is stripping in some cases both providers and clients of their autonomy to choose. So you and I are both practice owners. We are approaching this work from the fact that we've chosen this, this life work. We're invested in our communities, we're part of these communities. We care about what's happening, we care about our providers and you know, versus a platform, our venture capitalist backed platform that's coming in because they see it as an opportunity to make some money and they aren't part of the community and they haven't dedicated their lives to the same kind of thing. So there's this already starting out in that way. And then the terms that are negotiated for these platforms versus what an independent provider can do or what even a small business can do are very disproportionate. For instance, in Florida right now, new providers are being told that they must credential through headway in order to see their biggest insurer there, which is some form of Blue Cross Blue Shield. And that's what has to happen. And to us it seems like, okay, so in some states have any willing provider laws, and I don't believe that Florida is one of them. But you know, a person who wants to see a certain clinician should be able to see that clinician and use their insurance if that provider is willing to take it. But if that provider doesn't want to go through the middleman or that third party entity, that creates an issue. And there's very good reasons that people don't want to do that. We've had providers at my business, Bridge Counseling and Wellness, who have come over to us from platforms Like I said, we've had some who've left, and it's understandable why they did. And, you know, it's very mutually respectful. But we've also had some people come in from platforms and said that the data that they had, their contact with a client after something happened, like say a client didn't make a session or something like that, and the provider knows that that client is dealing with suicidal ideation and they are trying to make some room and stay in contact with that client. In one provider's case, they completely took the whole chart away and the client didn't have access to the information anymore and had to go. Not the client, but the provider had to go find this client, find other ways to connect the client, because the chart was just taken away. And so the decisions that are being made around that, there's also concern about, you know, data scraping that could be occurring. Oh, yeah, the motivations are different in these terms. There's just some risks there that we feel there needs to be definitely more. More laws around and more oversight around. And I think that's a big deal if it squeezes private practitioners and small businesses out. And we only have the option of working with these bigger platforms.

And Most of those MSOs that you're talking about are actually owned insurance companies.

Oh, exactly. So you're hitting a really important point, not only at the same time that we're dropping, our rates are being dropped. Like I said, I use the example at our practice. We just had it happen again in Kentucky with the MCOs. The across the board, they're just paying at 80%. Oh, I'm sorry, it's not across the board. It's at Passport Molina, in this case. But regardless, they dropped it to 80% of the fee schedule for everybody instead of 100% of the Medicaid B schedule. Right. So these, even the MCOs are owned by these Fortune 500 and sometimes even Fortune 5 companies. Right. These CEOs of these companies are making in the millions, actually, the salary that a CEO are making in a year ended up they made $60,000 a day, which is more than what the average clinician makes in a year. So in our mind, there's no job that is that far in disparity that the pay should be that different. Right. And honestly, I can't remember what the original question was. Sorry about that.

That's okay. No, no, no. You definitely answered it. And we're diving into some great things here. And we do short conversations on purpose to hold people's attention. So we are also almost out of time. I would love to know from you what is an important takeaway for anyone who cares about mental health, how it's delivered and what's happening right now. What do you see as some takeaways for people?

I would say that it's very important that we remember that we're not going to be able to compete with the financial resources that. That these big companies have. Some of them spend $3 million a month on advertising, for instance, and we're not going to be able to compete with that sort of financial security. But what we can do is we can really truly learn together how to harness the power of the people, how to start seeing ourselves as a collective that is stronger together and to use the power that we all have, especially as clinicians, the power of the heart, allowing our decisions to move from that space and to be willing to be strong in the heart. And to remember that it doesn't always mean, you know, our field is 84% women, for instance. It doesn't mean that we. Maybe it feels really good to give. It's a lot harder at times to stand firm and strong in your love, but that's a form of love too, because it's not just a problem in health care. More and more people, they call it the K economy, right? So it's. The disparity is getting larger and larger and something has to be done about it. Because if we continue at that pace, you know, unfortunately, money is what makes decisions, and you can buy your ability to make decisions in some cases. So what is the way that we can challenge that? We can learn how to truly work together as a collective and advocate and make some noise and take action together. Which is part of the reason why we encourage people to join the mental health insurance reform task force, specifically if you're a provider. Because we're taking collective action on very specific things. And we actually have made impact in a few situations. Just the recent Adnan Alma stuff. And we were able to get 2200 signatures in the Harry Ritter thing that it's provider voices who made a difference on them, reversing two of the three changes that they were going to make. I know you just said take away, so let me get briefer again. I also think it's important to remember that everybody has to make the decision that's best for themselves. We are certainly not judging anybody about what they need to do to survive. And you are always going to be the expert on yourself. And if you have capacity to contribute your time, your energy, or your voice to this movement. It is needed and it is wanted and we're trying to create something different than what we have seen in typical models. We're creating a circle of care where it's less based on hierarchy and more based on shared using our gifts in our own unique ways and making a web together to help hold not only our profession but also the clients that we really do want to serve and give care within that web and be stronger together. You're invited to a meeting. We meet the second Wednesday of every month at 11am Eastern Time or 8am Pacific Time as a full national group. But then we have several other groups that meet as well and we would really love you all to come and join us.

That's awesome. Nicole. I know that there are so many things that we could have talked about in addition to this, but I think your main message definitely got out there for all of our listeners. If you want to dive in more, all of the ways to connect and to get involved will be in our show notes for you. So please reach out and do that. And Nicole, I just appreciate how much you're doing and what you're building and thank you for helping us gather as a collective because advocating for wellness for ourselves, for our clients, for this industry is really important and honestly what this podcast is all about. So thank you.

Well, thank you so much, Rachel, for what you're doing as well. And it's an honor to be here with you. Thank you.

You bet. Before we wrap up, I want to share a few resources for listeners who want to dig in deeper into what we've been discussing today. These will all be linked in our show notes and newsletter. The first article from Mercer is called Trump Administration Puts Its Stamp on Mental Health Parody. This piece gives a clear overview of where MHPAEA enforcement stands right now. The Department of Labor's 2025 report to Congress, the pausing of the 2024 final rule, and what that means for providers going forward. The next article from Sequoia is called what Plan Sponsors need to know 2025 mental health parity Report to Congress, and this was released in May 2026. This breaks down what the federal government's own enforcement data shows and including the finding that none of the comparative analyses submitted by health plans were adequate on the first submission. If you want to understand why Nicole's work exists, this is a great place to start. Article 3 Capstone Partners Behavioral Health Care Service Market Update and this is from March 2026. Behavioral health deal activity rose nearly 50% year over year in 2025 for practice owners trying to understand the consolidation forces reshaping the field. This one is also worth the read. And lastly, article entitled Mental Health Insurance Reform Task, Progressive Advocacy Ladder and National Strategy. This is Nicole's own published framework for how providers can move from documenting payer harm to meaningful enforcement and fair reimbursement. A direct action resource for anyone who wants to get more involved. I want to thank you for joining us today and we will be back next week with more on the Mental Health Evolution Podcast. See you soon.