A recent evaluation report from the Center for Medicare & Medicaid Innovation (CMMI) highlights the growing role of integrated primary care services in the U.S. healthcare system through the Comprehensive Primary Care Plus (CPC+) model. According to the report, 45% of Track 1 providers co-located behavioral health services in their clinics in 2021, up from 34% in 2020. Track 2, which included practices adopting more nontraditional approaches to primary care, saw 68% of clinics co-locating behavioral health services, an increase from 64% the previous year.
These figures reflect the success of CPC+ in promoting integrated primary care services, demonstrating the value of combining physical and behavioral health care in one coordinated setting.
Understanding CPC+
Launched by CMMI in 2017, the CPC+ program was designed to test how primary care practices could collaborate with the federal government, health plans, and technology firms. Its goal was to enable primary care practices to transform how they deliver care, with a strong emphasis on integrated primary care services that address both physical and mental health needs.
Over its multi-year run, CPC+ impacted more than 17 million patients, providing clinics with the funding and support needed to implement innovative care models. While the program ended last year, its lessons continue to inspire initiatives such as Primary Care First, which carries forward the vision of delivering integrated primary care services to improve patient outcomes.
Behavioral Health Strategies Across CPC+ Practices
According to the recent report, all 3,070 primary care practices participating in CPC+ implemented some form of behavioral health strategy. Clinics could choose between two models:
- Primary Care Behaviorist model: Required onsite behaviorists to provide direct patient care.
- Care Management for Mental Illness model: Required care managers trained in behavioral health to coordinate patient care.
During program year four, 57% of practices chose the Primary Care Behaviorist model, 36% opted for Care Management for Mental Illness, and 5% used a combination of both. These options allowed clinics to tailor their approach to integrated primary care services based on their resources, patient population, and workflow.
Track Differences: Traditional vs. Nontraditional Models
CPC+ divided practices into two tracks to test different care delivery methods:
- Track 1: Built on traditional primary care with enhanced payments and program support.
- Track 2: Required practices to implement more nontraditional approaches, including reducing or eliminating fee-for-service payments and receiving advanced lump-sum payments.
Track 2 practices were more likely to co-locate behavioral health services, illustrating how flexible payment models can support integrated primary care services that combine mental and physical health care.
Funding Support Enables Integration
CPC+ provided significant funding to help clinics expand behavioral health offerings. Care management fees were reported as the most useful type of payment support for implementing integrated primary care services. These funds allowed practices to hire and maintain:
- Behavioral health providers and onsite behaviorists
- Care managers and coordinators
- Data analysts and population health specialists
- Clinical pharmacists
Such funding provided stability and sustainability for BHI efforts and ensured patients had access to comprehensive, coordinated care.
Challenges to Sustaining Behavioral Health Integration
Despite its successes, CPC+ highlighted several challenges for sustaining integrated primary care services:
- Workforce shortages: Difficulty finding qualified behavioral health professionals.
- Community resource limitations: Shortages of local behavioral health services.
- Patient resistance: Some patients were hesitant to engage in mental health services.
- Electronic health record limitations: Many EHR systems were not optimized for documenting behavioral health care.
While CPC+ funding made BHI financially feasible, practices expressed concerns about sustaining integrated primary care services after the program ended. Some clinics are billing insurers for behavioral health services, but others remain uncertain about long-term financing.
Looking Ahead
Although CPC+ has concluded, its legacy continues to shape primary care innovation. The program demonstrated that integrating behavioral health into primary care is both feasible and valuable, and that integrated primary care improve patient outcomes by addressing the whole person—both physical and mental health. Lessons from CPC+ continue to inform initiatives like Primary Care First, ensuring that the benefits of integrated primary care reach more patients nationwide.
