The opinions expressed in this piece are solely the author’s and do not necessarily reflect the views of Carolina Journal or its publisher.
We all want a health system that helps people before they reach a breaking point. Yet across North Carolina, too many individuals struggle to find timely, affordable mental health care when they need it most. From both the exam room and the health plan perspectives, we see that when mental health needs go unaddressed, people end up in higher-cost (and often less effective) settings, and families carry the burden. Solving that shared challenge requires care teams and payers to work together to integrate mental health into primary care and pay for it in a way that makes quality, coordinated care sustainable.
North Carolina faces severe access challenges, ranking 38th nationally in mental health access, which underscores the need to meet patients where they already receive care and reduce reliance on costly emergency visits and hospitalization. Many conditions can be effectively treated in primary care using proven, evidence-based approaches like the Collaborative Care Model (CoCM), which help patients earlier and address long-term needs.
Yet, despite strong evidence, access to these models remains limited, especially for patients with the most complex needs. This adds unnecessary stress on the system and drives up costs, while data tends to indicate a rise in diagnosis of anxiety for adolescents when compared to pre-pandemic levels. When mental health care is disconnected from primary care, those at highest risk often have the least coordinated support, making it harder to manage conditions early and avoid costly escalation.
Integrated Care in Action
In our respective roles, we’re accountable to the same goal: helping people get the right support early, close to home. Across North Carolina, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has expanded its network by more than 10,000 mental health providers since June 2022, helping make it easier for families across North Carolina to find in-network care earlier, when support can have the greatest impact. When access is limited, the impacts ripple across the system from delayed treatment, avoidable emergency visits, and higher costs. Integrated mental health models address that system problem by enabling early identification of mental health challenges, coordinated treatment, and sustained follow-up in primary care.
One example is how Sandhills Pediatrics and Blue Cross NC are working together to expand access to integrated mental health care through an innovative, patient-centered partnership. By bringing mental health into the pediatric setting, care teams can identify concerns during routine visits, connect patients to the appropriate level of support, and coordinate care over time. This approach helps families receive care in a familiar, trusted setting — while reducing reliance on emergency and other high-cost interventions.
By aligning payment with quality, engagement, and outcomes, this partnership helps providers deliver integrated care earlier and more consistently, addressing a key driver of cost and complexity in the system.
An Evolving Payment Model
Historically, payment for mental health care has been fragmented, often separating mental health from primary care. Our work together at Sandhills Pediatrics reflects a different approach: a pay-for-performance model tied to quality and engagement measures, including the use of evidence-based screening tools. Compared with traditional fee-for-service reimbursement, this model is designed to:
Support integrated primary and mental health care
Shift away from traditional flat, fee-for-service reimbursement
Incentivize practices for performance
Rewarding practices for improving access to high-quality, coordinated mental health care is worth exploring across the broader health care system. The Blue Cross NC-Sandhills Pediatrics partnership offers a practical example of how aligning effective care delivery with payment can expand access and strengthen outcomes.
If we want to address rising health care costs and improve outcomes, we must invest in models that address conditions before they escalate into crises. The collaboration between Blue Cross NC and Sandhills Pediatrics demonstrates how providers and payers can share responsibility for building integrated mental health capacity in primary care and ensuring the payment structure supports treatment options the evidence shows works. Expanding access to integrated care is a practical, scalable step toward a more affordable and effective health system for North Carolina.