Access, Engagement, and Depression and Anxiety Outcomes in an Employer-Sponsored Virtual Behavioral Health Program: A Retrospective Cohort Study

BackgroundMental health (MH) conditions impose a growing burden on US employers through lost productivity, absenteeism, and downstream medical use.Timely access to MH care remains an unmet need, particularly in underserved and rural communities.Employer-sponsored models that integrate behavioral health with primary care may improve access and outcomes, but evidence is limited. ObjectiveThe primary objective was to describe access to care and engagement among members who completed at least one visit with the virtual MH program at First Stop Health, an integrated employer-sponsored health platform, during 2025.The secondary objective was to describe change in depression and anxiety symptoms among members with clinically elevated baseline symptoms and follow-up assessments. MethodsThis retrospective cohort study included 1,480 members who completed at least one MH visit between January 1 and December 31, 2025 (study cohort), used for all access and engagement analyses.Symptom outcomes were analyzed in a nested outcome cohort (N = 298) with a baseline Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) score ≥ 10 and at least two assessments on each instrument.Outcomes included time to first visit, visit completion, remission (any post-baseline score < 5), response (≥ 50% decrease and score < 10, or remission), and clinical improvement (≥ five-point decrease, or response or remission). ResultsThe median time from scheduling to first visit was seven days; 54.5% (N = 807) of members were seen within seven days and 82.8% (N = 1,226) within 14 days.Access was similar for the 27.3% (N = 404) of members living in mental health professional shortage areas.Two-thirds (66.0%,N = 977) completed two or more visits.Members using two or more service types had lower dropout after the first visit than those using one (25.7% vs. 39.5%;p < 0.001).In the outcome cohort, remission was achieved by 53.7% (N = 160) on the PHQ-9, 44.0% (N = 131) on the GAD-7, and 60.1% (N = 179) on either instrument, and clinical improvement by 62.1% (N = 185) and 59.1% (N = 176), respectively.Members seen within seven days had numerically higher remission (61.9% vs. 57.4%;p = 0.47) and clinical improvement (76.7% vs. 67.2%;p = 0.09).At the latest assessment, 28.9% (N = 86) were in remission on both instruments. ConclusionsA virtual, integrated employer-sponsored MH program delivered timely access across diverse geographies, including shortage areas, and most members with elevated symptoms improved.Earlier access to care was associated with better outcomes, and use of multiple service types was associated with greater engagement.These findings support embedding virtual behavioral health within integrated employer-sponsored health platforms.