Millions of Americans struggle to get treatment for mental health conditions, and this integrated model of care can help health systems rise to the challenge.
For health systems, there are multiple benefits from integrating behavioral health services into primary care practices, a pair of CMOs say.
The United States is experiencing a mental health crisis, according to the Centers for Disease Control and Prevention and research published last year by the Johns Hopkins Bloomberg School of Public Health. According to the CDC, 4.8% of adult Americans have regular feelings of depression and 12.1% have regular feelings of worry, nervousness, or anxiety. In 2024, nearly a third of the 50 million Americans with mental health conditions were unable to get treatment, according to Mental Health America.
For health systems, integrating behavioral health into primary care practices is a successful strategy for improving access to care, according to Edward Yu, MD, CMO of population health clinical integration at Sutter Health.
“For patients, having behavioral health services integrated into primary care improves access to care because it is much easier for patients to get primary care appointments compared to specialty care appointments,” Yu says.
At any large health system, the prevalence of behavioral health conditions far surpasses the capacity of specialty care networks of psychologists and psychiatrists, according to Zia Agha, MD, CMO of West Health Institute.
“There is an opportunity for health systems to engage with patients who have behavioral health conditions in the primary care venue,” Agha says.
In addition to boosting access to care, integrating behavioral health services into primary care practices has several other benefits.
“From a clinician standpoint, having behavioral health services integrated into primary care can ease workflows and provide primary care clinicians with support to serve patients with behavioral health needs,” Yu says. “This allows primary care clinicians with an ability to take care of more patients and to practice more efficiently.”
Adopting an integrated care model improves the physical health conditions of patients, Agha explains.
“It is well known that uncontrolled behavioral health conditions such as depression can have a negative impact on physical conditions such as diabetes and heart disease,” Agha says. “So, an integrated model can make it easier for primary care practices to manage patients’ physical conditions.”
Integrated care models also reduce cost of care and address reimbursement challenges for health systems, according to Agha.
“Compared to specialty models, integrated models of care cost a few hundred dollars per patient per month versus thousands of dollars per patient per month for specialty care,” Agha says. “In addition, Medicare and most insurance companies provide reimbursement for services offered through an integrated model of care.”
Best Practices for Integrating Behavioral Health into Primary Care
A key to success in integrated care models is taking a systematic approach to providing behavioral health services at primary care practices, according to Agha.
Agha says a systematic approach includes the following: identifying and screening patients; prioritizing and enrolling patients for care; treating patients in a team-based setting with the support of a behavioral health case manager, psychologist, or psychiatrist; and addressing the population health need.
“What is needed is not a one-off approach but a systematic approach,” Agha says. “That is what integrated care models offer to a health system CMO who wants to address behavioral health needs in their patient population.”
CMOs and other senior leaders should embed integration models into existing primary care workflows, Agha explains.
“Every primary care clinic that is going to participate in an integrated model of care must be cognizant of their workflows, team-based approach to care, and the dynamics of integrating care,” Agha says. “An integrated model of care should not be seen as a bolt-on feature at a primary care practice. An integrated model of care should be seen as part of day-to-day operations.”
Yu says Sutter Health has three models for integrating behavioral health into primary care practices:
Behavioral health staff embedded in primary care practices serve as care navigators to help connect patients with behavioral health services. The care navigators help connect patients with behavioral health clinicians at the health system as well as resources in their communities.
Embedding behavioral health services within primary care practices such as clinically licensed social workers who are co-located with primary care physicians. The PCPs can take on the behavioral health needs of patients over the short term or long term, then perform warm handoffs to behavioral health clinicians to support the care of patients in a way that fosters adherence to care plans.
Using telehealth to connect patients with virtual behavioral health teams to support patients in primary care practices, which allows the health system to serve more patients and expand care without physically embedding behavioral health clinicians at clinic locations.
Harnessing data is essential for integrated care models and Sutter Health tracks several measures, according to Yu.
“The easiest ones are tracking the volume of patients who are served in integrated models of care, the number of referrals we are generating, and the number of days it takes for patients to connect with behavioral health services,” Yu says. “We also track outcomes, where we use standardized instruments for common conditions such as depression and anxiety.”
Sutter Health has posted impressive results from the health system’s integrated care models. The program has demonstrated rapid growth and broad adoption, with more than 15,000 referrals, more than 10,000 enrollments, and more than 3,300 active patients. Access to care has been timely, with enrollment for services typically within about five days of a referral. Clinical outcomes have improved, including about 48% of patients achieving clinically significant improvement in depression scores at 90 days.
Advice for Launching and Implementing Integrated Care Models
CMOs and other senior leaders should think about integrating behavioral health services into primary care in terms of health system strategy, according to Agha.
“Often, there is a tremendous need and desire to have system-wide initiatives that address burning pain points in healthcare such as access to care, capacity, reimbursement, and workforce shortages,” Agha says. “The integrated care models address each one of those pain points.”
Engaging the workforce and frontline leaders such as physicians from the start of any effort to adopt and implement an integrated model of care is important, Agha explains.
“These models are best deployed and implemented when everybody involved sees themselves as an equal partner and they feel they have a stake in delivering care and achieving better outcomes,” Agha says.
It is less important to pick a particular model for integrating behavioral health into primary care practices than it is to start the effort, according to Yu.
“My main advice to CMOs and other senior leaders at health systems is to start somewhere,” Yu says. “If they don’t embrace some level of integrated care, patients will often face challenges in accessing care.”