Integrating behavioral health services into the broader healthcare ecosystem has become an essential goal for many organizations, yet it continues to present a significant challenge in today’s complex healthcare environment. As healthcare systems strive to improve patient outcomes and deliver more holistic care, integrating behavioral health services is often seen as a key strategy. However, despite the growing recognition of its benefits, many health systems still face hurdles in driving consistent engagement and referrals to behavioral health services. As Andrew Bertagnolli, the national director of virtual behavioral health services at One Medical, shared during a panel discussion at INVEST 2023, there is a risk that referrals to behavioral health services may diminish, even in environments where these services are embedded within primary care.
One of the central challenges in maintaining robust behavioral health referrals is the risk of them trailing off in virtual or add-on solutions. Bertagnolli explained that when behavioral health services are not continuously promoted within the primary care setting, they can fade from the forefront of providers’ and patients’ minds. This issue is particularly prevalent in virtual models of care, where patient engagement can be harder to maintain. As a result, health systems must find ways to continually highlight the value of integrating behavioral health services, or else they risk seeing referral rates plummet, even in primary care settings where behavioral health should ideally be integrated into routine care.
To address this, One Medical has developed a strategy aimed at embedding behavioral health into the very fabric of its practice. For instance, One Medical trains its primary care providers early in their tenure about common behavioral health conditions and the company’s approach to treating them. The organization’s proprietary electronic health record system also plays a significant role, allocating dedicated space to behavioral health issues, ensuring they are included in patient records and care plans. Moreover, primary care providers have the opportunity to work alongside master’s-level mental health clinicians and psychiatrists who conduct virtual rounds, helping to address behavioral health concerns alongside primary care needs. While this integrated approach has been successful in many ways, it also highlights a common challenge faced by organizations attempting to provide comprehensive care: keeping behavioral health services top of mind for patients and providers alike.
In-Person vs. Virtual Care: A Balancing Act
While virtual care has become an essential component of integrating behavioral health services, many organizations still see significant value in offering in-person behavioral health services. Sentari Minor, vice president of strategy and chief of staff at evolvedMD, argued that having behavioral health providers physically present in primary care settings allows for more seamless collaboration between providers and improved patient outcomes. EvolvedMD’s model, which operates with 70% of its services co-located in primary care practices, emphasizes the importance of ensuring that behavioral health providers are seen as an integral part of the care team. According to Minor, when behavioral health providers are on-site and working alongside primary care teams, it fosters a stronger sense of collaboration and a more cohesive care experience for patients.
The appeal of in-person integration is not only about fostering better relationships between patients and providers but also about creating a stronger case for integrating behavioral health services when negotiating with large health systems or potential partners. As Minor pointed out, many health systems recognize the benefits of virtual care but still prioritize having on-site behavioral health services. The in-person model can serve as a differentiator, helping to establish trust with patients and providers, while also providing a clear and tangible connection between primary care and behavioral health services. However, the key challenge lies in balancing the need for in-person care with the flexibility and scalability offered by virtual care.
In contrast, virtual care models have proven to be highly effective for some organizations, particularly in providing more frequent and shorter interventions that help patients stay engaged with their treatment. Spencer Hutchins, co-founder and CEO of Concert Health, shared that his organization has not observed any significant difference in patient engagement or outcomes between in-person and virtual care models. For Concert Health, providing more frequent interactions, often through virtual channels, has led to positive patient outcomes. The ability to connect with patients outside of the traditional clinic setting removes barriers such as travel, wait times, and scheduling issues, making it easier for patients to access care. While virtual care may present challenges, especially in maintaining the collaborative nature of care, it also opens up opportunities for more flexible and efficient treatment delivery.
Overcoming Obstacles to Integration
The road to effective integration of behavioral health services is fraught with obstacles, and the path to success often requires overcoming significant philosophical, logistical, and administrative barriers. One of the primary challenges is convincing primary care providers to embrace the idea of behavioral health integration. Many primary care providers already address mental health concerns on a regular basis, and some may resist the idea of involving behavioral health specialists in their care processes. This resistance can stem from a belief that behavioral health care doesn’t belong in a primary care office or a perception that they already know how to manage mental health issues within their patient populations. Overcoming these objections requires demonstrating the value of collaborative care models, showing primary care providers that integration can improve patient outcomes and alleviate some of the burdens they face when addressing mental health concerns on their own.
On the administrative side, the process of integrating behavioral health services into primary care can be slow and complex. For instance, evolvedMD’s experience with securing a partnership with Banner Health, the largest health system in Arizona, demonstrates the lengthy sales cycles that many health systems face when trying to implement behavioral health integration. Gaining buy-in from large organizations and overcoming administrative red tape can take years, making it difficult to rapidly scale these models of care. Moreover, the financial barriers to integration are significant. While Medicare and Medicare Advantage plans typically cover services provided under the Collaborative Care Model (CoCM), there are still gaps in Medicaid coverage. These gaps create challenges for organizations attempting to sustain behavioral health integration in a way that ensures long-term viability.
The Need for Proactive Support and Collaboration
Ultimately, the success of integrating behavioral health services hinges on ongoing efforts to engage and educate both providers and patients. It is essential for health systems to continue promoting behavioral health services as a core component of primary care, whether through virtual or in-person care models. Providers need to recognize the value of collaborating with behavioral health specialists, and patients must be encouraged to view mental health services as an integral part of their overall health and well-being.
For organizations like One Medical, evolvedMD, and Concert Health, the focus on collaborative care models—whether virtual, in-person, or hybrid—requires continuous vigilance and leadership. Effective integration can be achieved when providers work together to address both physical and behavioral health needs, creating a holistic care experience for patients. However, this requires ongoing collaboration, a commitment to continuous improvement, and a willingness to invest in systems that prioritize mental health as part of the overall care continuum.
As health systems continue to evolve, it is clear that integrating behavioral health services will remain a critical component of patient-centered care. For the model to succeed on a larger scale, stakeholders across the healthcare ecosystem must be committed to overcoming the barriers to integration, advocating for sustainable reimbursement models, and building trust and collaboration across care teams. Only by addressing these challenges head-on can we create a healthcare environment where both physical and mental health are treated with equal importance, ensuring better outcomes for all patients.
