Oak Street Health (NYSE: OSH), a fast-growing primary care provider focused on older adults, is redefining what integrated behavioral health for seniors looks like within the U.S. healthcare system. Operating over 125 locations across 20 states, the Chicago-based organization is pioneering a value-based care model that embeds mental health services directly into primary care. By combining in-person and telehealth strategies through the IMPACT collaborative care model, Oak Street is boosting health outcomes and improving seniors’ quality of life.
The stakes are high: successful integrated behavioral health for seniors could save the healthcare system billions. A 2014 Milliman report estimated potential cost reductions of up to $48 billion annually. Oak Street’s model tackles these challenges head-on by focusing on whole-person care—emphasizing prevention, wellness, and mental health management as key to lowering costs and improving outcomes.
The Role of Behavioral Health in Value-Based Senior Care
Mental health conditions such as depression and anxiety often complicate chronic disease management in older adults. Oak Street recognizes this overlap and treats integrated behavioral health for seniors as essential to effective primary care.
Vice President of Clinical Services Katherine Suberlak shared that around 60% of Oak Street patients benefit from behavioral health integration. Their collaborative care model is showing results: 43% of patients experience significant improvement in depressive symptoms—compared to just 19% under traditional care models. These findings underscore how a proactive and connected approach makes integrated behavioral health for seniors more effective.
Embedding Behavioral Health in Everyday Primary Care
At Oak Street, new patients are assigned a multidisciplinary team that includes both medical and behavioral health professionals. These teams perform comprehensive assessments for conditions such as depression and substance use disorders.
A standout aspect of their approach is the 98% depression screening rate during annual wellness visits. For a population vulnerable to isolation and psychosocial stress, this level of monitoring ensures that integrated behavioral health for seniors is not a one-time service, but an ongoing priority.
Personalizing Care Through Community and Clinical Support
Once a behavioral health concern is identified, the care team creates a tailored treatment plan. These plans are supported not only by clinicians but also by social workers and community health workers. These professionals play a crucial role in making integrated behavioral health for seniors more accessible and effective by addressing social determinants of health and extending care into patients’ homes and communities.
Suberlak describes these social workers as “health coaches,” helping maintain continuity and improve adherence, particularly for those with complex needs or limited access to traditional care.
Hybrid Care Delivery: A Blend of Telehealth and In-Person Services
Oak Street began integrating telehealth into its model in 2017, well before the COVID-19 pandemic pushed the industry toward virtual care. Their hybrid model is particularly impactful for behavioral health, where workforce shortages and geographic gaps persist.
Though many seniors prefer in-person visits, the ability to offer both virtual and on-site services has made integrated behavioral health for seniors more flexible and scalable. The model respects patient preferences while maximizing clinician availability—essential in the face of rising demand.
Expanding Access Through Technology and Consultation Platforms
To further extend behavioral health support, Oak Street acquired RubiconMD in 2021 for $130 million. This virtual consultation platform enables primary care doctors to access specialty input in real time, reducing delays and enhancing care coordination.
This move aligns with the organization’s goal of expanding integrated behavioral health for seniors without increasing patient burden. Each consultation also translates into significant savings—$500 to $800 per patient—highlighting the financial value of this approach.
Adapting to Workforce Challenges
Workforce shortages in behavioral health remain a national issue. Oak Street is overcoming these barriers by utilizing licensed clinical social workers remotely and rethinking outdated care delivery models. However, limitations such as Medicare’s exclusion of certain provider types still restrict hiring options. Continued policy reform is needed to support the scalability of integrated behavioral health for seniors across more locations.
Long-Term Monitoring and Community Collaboration
A cornerstone of Oak Street’s model is consistent follow-up. Behavioral health assessments are conducted regularly—at six weeks, six months, and as needed—ensuring patients receive ongoing support. Many show meaningful progress within six weeks, and almost half sustain improvements over time.
This ongoing engagement exemplifies how integrated behavioral health for seniors works best when care is dynamic and patient-centered.
When patients require more intensive services, Oak Street’s care teams collaborate with external community providers. This ensures that even the most complex behavioral health cases receive the right level of care, at the right time. These partnerships strengthen the model of integrated behavioral health for seniors, making it truly comprehensive and coordinated.
Conclusion
Oak Street Health is setting a new standard in senior care by embedding mental health services directly into the primary care experience. Through its hybrid delivery model, strong community ties, and continuous patient engagement, the organization exemplifies how integrated behavioral health for seniors can improve both outcomes and costs.
As the nation moves toward more value-based systems, Oak Street’s approach offers a compelling roadmap for what compassionate, effective, and scalable care can look like—especially for the growing senior population.
