For decades, healthcare providers have recognized that physical and mental health overlap. Integrated behavioral health is a team-based care model that merges the primary medical and behavioral healthcare fields.
This piece gives primary care leaders and care teams who are considering behavioral health integration a concrete picture of what it looks like. It also straightforwardly answers, “How do we know that it’s working?”
Article Highlights
- Integrated behavioral health is a team-based care model that merges the primary medical and behavioral healthcare fields.
- Primary care clinicians already deliver most mental health services and provide behavioral health care, making them key team members in every integrated care model.
- Measurement-based care (MBC) is the foundation of most care models, supporting team operations and providing objective data to measure success.
Primary care within the behavioral health care framework
Over 20 years ago, the President’s New Freedom Commission on Mental Health noted that “mental health is the key to overall physical health.” A decade later, professional associations and federal agencies were voicing a need to integrate the medical and behavioral health fields, including primary care.
“Integration” means unification, which implies absorbing an entirely separate system, and sounds time-consuming and stressful. However, in the scope of general health, the boundary between medical and behavioral health is artificial — primary care is the gateway to general health, and in reality, primary care clinicians already provide behavioral health care.
What integrated behavioral health looks like in primary care
Fully integrated care happens when physical healthcare and behavioral healthcare clinicians contribute to a unified care plan tailored to the patient’s unique needs and social wellbeing.
There are two other levels of behavioral health care integration:
- Coordinated Care: Primary physical healthcare and behavioral healthcare systems are completely separate, connected only by a referral system. Information sharing and collaboration are limited after the patient referral.
- Colocated Care: The primary physical healthcare and behavioral healthcare practices are in a shared location. Although a clinician with expertise in the primary diagnosis manages the patient, the likelihood of collaboration and information sharing increases.
Recognized fully integrated care models and their care teams
Behavioral health care team members and their roles vary depending on the integrated care model. Two common models include the Collaborative Care Model and Primary Care Behavioral Health.
Collaborative Care Model
The Collaborative Care Model (CoCM) includes three core team members: the primary care clinician, a behavioral health care manager (BHCM), and a consulting psychiatrist.
| Team member | Responsibilities |
|---|---|
| Primary care clinician |
|
| Behavioral health care manager |
|
| Consulting psychiatrist |
|
Primary Care Behavioral Health
Primary Care Behavioral Health (PCBH) includes two core team members: the primary care clinician and the licensed behavioral health clinician (BHC), often a psychologist.
| Team member | Responsibilities |
|---|---|
| Primary care clinician |
|
| Behavioral health clinician (e.g., a psychologist) |
|
Ensuring efficient and successful whole-person care
Behavioral health integration is only as strong as what the team can measure and share.
Team sharing
Members have different personalities, beliefs, training, and expertise, and to achieve a common treatment goal, they need shared access to:
- Practice guidelines and resources
- An internal communication platform
- An EHR system with two-way notes
- Integrated easy-to-use, digitized screening and assessment tools
- Instant results and reports
Team measuring
Innate human differences predispose patient input and team member decisions to subjectivity — using measurement-based care minimizes this risk. Measurement-based care compares standardized and validated assessment tool results, taken at baseline and repeated during the care plan, to measure progress.
Primary care clinicians use repeated, objective physical health measurements daily, from BMI to blood pressure, as the standard of care. Measurement-based care adds mental health assessments, using:
- Symptom scales, e.g., PHQ-9 and GAD-7
- Daily life functional outcomes
- Cognitive and behavioral assessment programs
Workflow flexibility: from all ages to telehealth services
Sometimes, one measurement-based care tool is multifunctional, offering workflow flexibility. For example, certain web-based cognitive assessments:
- Screen for multiple mental health conditions
- Screen children and adults
- Allow virtual or in-person consultations
Measurement-based care: reducing workloads and connecting teams
For some primary care practices, the implementation costs and timelines of the CoCM and PCBH are real barriers. However, measurement-based care is vital for even these “classic” care models, and tools used in measurement-based care are rapidly implemented, add workflow flexibility, are low-cost, use existing staff and hardware, and have few IT requirements.
The concept of MBC as a standalone integrated care model
In a 2024 article, “Measurement-Based Care: A Practical Strategy Toward Improving Behavioral Health Through Primary Care,” Carlo et al. highlight “MBC itself as a solitary strategy.”
Primary care clinicians already deliver most mental health services and prescribe 60% of psychotropic medications. If the classic behavioral health models are not viable, primary care settings can introduce mental and cognitive health assessment tools as a standalone MBC model, or foundation for future integration.
Measuring integration success with objective data
One gauge of integrated care success is positive patient outcomes. EHR-integrated MBC allows tracking, measuring, and sharing of treatment progress, which has across-the-board advantages:
- Team coordination: Instant availability of cognitive and behavioral assessment results provides objective, measurable data to all team members and helps inform their decisions: adjust medication, request more information, or refer.
- Administrative benefits: Healthcare leadership and funders require objective, measured changes as evidence of patient well-being and behavioral health care services’ success.
Adopting measurement-based care: the natural next step
EHR-integrated assessment tools carry weight as primary care practices transition through behavioral health integration levels. These digital platforms are quick to implement, keep objective health data flowing across team roles, and turn “we think this is helping” into measured evidence that it is. If it is not already in place, measurement-based care is the natural next step in integrated primary care.
Written by Dr. Dorianne Green, Medical Writer
Dr. Green is a physician-turned-medical writer with over two decades of clinical experience in primary care and as chief clinician for a geriatric and dementia care unit. Her special interests are mental health and trauma-informed care.