Integrating behavioral and physical health care is one of the most promising strategies in modern health care delivery. By combining the treatment of mental health conditions, substance use disorders, and physical illnesses into a coordinated approach, providers can achieve better patient outcomes while reducing overall costs. Yet, while the idea of integrated care is widely accepted, putting it into practice is often far more complex.
This challenge—and the lessons learned from organizations that have been successful—was the focus of a recent panel discussion at the 2020 Health Care Payment Learning & Action Network (LAN) Virtual Summit, held on October 13. Panelists representing payers, providers, and policymakers shared insights into what it takes to make behavioral-medical integration work in real-world settings. Their message was clear: achieving successful integration requires patience, aligned quality measures, supportive payment models, and innovative technology.
Why Integrated Care Matters
The importance of integrating behavioral and physical health care cannot be overstated. Studies show that untreated mental health and substance use disorders often worsen physical health conditions, driving up health care costs and leading to poor patient outcomes. Conversely, patients who receive holistic, coordinated care experience improved quality of life, better adherence to treatment plans, and fewer hospitalizations.
Despite these proven benefits, systemic barriers make integration difficult. Traditional health care systems are fragmented, with behavioral health and medical care siloed in separate networks, funding streams, and cultures. Overcoming these divisions requires intentional strategies and long-term investments.
Commitment And Patience Are Essential
One of the strongest themes from the panel discussion was the importance of patience and organizational commitment. Victor Wu, chief medical officer at TennCare—Tennessee’s Medicaid program—emphasized that integrated care initiatives cannot be judged by short-term results.
“No matter if you’re a provider organization or state agency or you are a payer, there’s got to be some level of commitment at the organizational level to allow this to run out for several years,” Wu explained. “That ROI can’t just be looked at in one or two or three year chunks—it’s got to be a much longer view than that.”
Wu’s perspective comes from direct experience. TennCare currently oversees two major delivery system transformation initiatives: Patient-Centered Medical Homes and Tennessee Health Link. Both programs aim to integrate behavioral and physical health services for different patient populations.
These initiatives took years to show progress. According to Wu, TennCare saw no savings in the first two years. Only by year three did the program begin breaking even, and it has not yet shown a positive return on investment. Still, Wu and his colleagues are confident that the long-term benefits will justify the initial costs.
This insight underscores a reality that many health systems must accept: integrated care requires upfront investment in infrastructure, workforce, and technology. Financial gains may take years to appear, but the potential payoff—improved patient health and reduced system-wide costs—makes the wait worthwhile.
The Role Of Quality Measures In Driving Success
While patience is important, concrete strategies also play a critical role in ensuring success. Judy Zerzan-Thul, chief medical officer at the Washington State Health Care Authority, highlighted the importance of quality measures. Her agency oversees Medicaid, state employees, teachers, and retirees, giving her a broad view of health system performance.
Zerzan-Thul stressed the need for alignment of quality measures across all parties involved in integration. When providers, payers, and policymakers share the same goals and benchmarks, it becomes easier to identify priorities and track progress.
“Alignment of focused measures can help people get their arms around what’s the most important thing and how can I move that measure?” she said. “And then looking at how to do that in a team-based way.”
For example, a health system might focus on reducing hospital readmissions for patients with co-occurring diabetes and depression. By aligning quality measures around this shared goal, providers across disciplines can collaborate more effectively, ensuring that both physical and behavioral health needs are addressed in tandem.
Without aligned measures, integration efforts risk becoming fragmented, with each stakeholder pulling in a different direction. Alignment helps focus energy and resources on strategies that make the greatest impact.
Technology As A Catalyst For Integration
Another key theme discussed during the panel was the role of technology in supporting integrated care. Greg Poulsen, senior vice president of policy at Intermountain Healthcare, shared how his organization has leveraged telehealth to expand behavioral-medical integration.
Intermountain first began experimenting with integrated care nearly 15 years ago, but its efforts have accelerated dramatically in recent years thanks to advances in technology. Telehealth now allows Intermountain to bring behavioral health professionals into nearly every exam room, bridging the gap between medical and mental health care.
“Technology today allows us with telehealth to do care integration vastly more efficiently and effectively than when we started,” Poulsen said.
Telehealth has proven especially valuable during the COVID-19 pandemic, when demand for behavioral health services skyrocketed while in-person visits became more difficult. For patients in rural or underserved areas, virtual care also helps eliminate geographic barriers to accessing integrated treatment.
Payment Models Must Support Integration
While technology and aligned measures provide the framework, sustainable payment models are essential to keep integrated care initiatives viable. Traditional fee-for-service payment structures often discourage collaboration between behavioral and physical health providers. Instead, they reward volume of services over value and outcomes.
Programs like TennCare’s Patient-Centered Medical Homes and Tennessee Health Link are shifting away from fee-for-service and toward per-member per-month payments or case rates. These models incentivize providers to focus on holistic care and long-term patient outcomes rather than short-term transactions.
Poulsen emphasized the importance of aligning payment models with integration goals. “I think the key is to get the payments so that you can bring those together and people can get appropriately compensated for it,” he said.
Without payment reform, even the best-designed integration efforts may struggle to survive. When reimbursement structures reflect the value of coordinated care, providers have both the resources and motivation to sustain integration.
Lessons For Providers Starting The Journey
For providers just beginning their integration journey, the panelists offered practical advice:
- Commit to the long-term. Integration is not a quick fix. Leadership must be prepared to invest resources and maintain momentum over years, not months.
- Align quality measures. Establish shared benchmarks across stakeholders to focus on the most important outcomes and avoid fragmentation.
- Leverage technology. Use telehealth and data-sharing platforms to bridge gaps and expand access to behavioral health specialists.
- Reform payment models. Advocate for payment structures that reward integrated care, such as capitation or case rates, instead of fee-for-service.
- Foster collaboration. Encourage team-based approaches where behavioral and physical health professionals work together to address the whole person.
Conclusion
Integrating behavioral and physical health care is a complex but necessary evolution in the health care system. As the panelists at the 2020 LAN Virtual Summit emphasized, success depends on patience, aligned quality measures, effective use of technology, and supportive payment models.
While results may take years to materialize, the benefits of integration are undeniable: improved patient outcomes, reduced costs, and a more holistic approach to health care. For organizations willing to invest the time, effort, and resources, behavioral-medical integration offers a path toward a healthier and more sustainable future.
