Primary care has historically been at the core of value-based care agreements, but the healthcare landscape is rapidly evolving. Traditionally, value-based care focused on improving health outcomes while controlling costs, primarily through primary care providers (PCPs) who coordinated preventive services, chronic disease management, and overall patient health. Now, there is a growing recognition that mental health plays a crucial role in patient outcomes. Integrating behavioral health into primary care through primary care collaboration is becoming an essential strategy for improving patient health and reducing costs.
Experts in the field believe this trend opens the door for collaborative care models that combine behavioral and physical health services under a single framework. Christopher Brengard, CEO of Mindpath Health, emphasized this during Behavioral Health Business’ INVEST event, stating, “Patients that are underserved from a mental health standpoint, or [those] having issues that are not being addressed, do poorly physically. And we know that people that are challenged physically are having issues around mental health. It only makes sense to throw those two together.” Mindpath Health, which operates more than 100 outpatient behavioral health locations across seven states and serves nearly 100,000 patients annually, illustrates the scale at which integrated care models and primary care collaboration can make an impact.
The Case for Integrating Care for High-Acuity Patients
The need for integration is especially urgent for high-acuity patients, such as individuals with serious mental illnesses (SMI) including schizophrenia, bipolar disorder, and major depression. Research published in the Annals of General Psychiatry shows that these individuals have a life expectancy 10 to 25 years shorter than the general population. Often, their physical health needs are overlooked, and untreated mental health issues can exacerbate chronic conditions such as diabetes, heart disease, and obesity.
By aligning behavioral and primary care, providers can better address the holistic needs of these patients. Not only does this improve clinical outcomes, but it also has the potential to reduce avoidable hospitalizations, emergency room visits, and costly complications. David White, CEO of BayMark Health Services—a leading provider of substance use disorder (SUD) treatment with more than 400 facilities across the U.S. and Canada—stated, “There are real opportunities to save money and provide really good, quality care.” For providers operating at scale, integrated care and primary care collaboration represent both a clinical and financial advantage.
Financial and Operational Challenges
While the benefits are clear, integrating primary and behavioral health care is not without challenges. One major difficulty lies in determining which provider is responsible for cost savings under value-based care models. Brengard explains, “If you start saying, ‘The spend on this patient was $10,000 this year compared to $15,000 last year, who was responsible for that savings?’ You’re going to get 100 hands in the room that said, ‘That was me.’”
In many cases, trying to assign credit for cost reductions can create conflict. Instead, experts suggest forming partnership agreements where the focus is on overall patient outcomes rather than individual financial attribution. When providers collaborate in good faith, the collective effort can yield significant improvements in both health outcomes and cost efficiency, even if it is impossible to determine precisely who is responsible for each dollar saved. Primary care collaboration focuses on this kind of holistic approach, putting patient well-being ahead of individual credit.
Patient preference also adds complexity. Some individuals resist fully integrated care, preferring to keep behavioral and primary care services separate. White explains, “Everyone thinks it should just happen automatically. But the reality is some patients don’t want their primary care for their addiction treatment provider, or vice versa.” Respecting patient autonomy while still providing coordinated care requires careful planning, clear communication, and sensitivity to privacy concerns.
Momentum Toward Integration
Despite these challenges, integration is accelerating. A recent report indicates that 45% of primary care providers participating in the Center for Medicare & Medicaid Innovation’s Comprehensive Primary Care Plus (CPC+) model were co-locating behavioral health services in their clinics. This trend highlights that primary care providers recognize the value of embedding behavioral health professionals into their care teams, particularly for managing complex patients with comorbid conditions.
A compelling example comes from Refresh Health, an outpatient mental health provider recently acquired by UnitedHealth Group’s Optum division. With more than 300 locations across 37 states, Refresh Health provides treatment for SUD, mental health disorders, eating disorders, couples therapy, and psychiatry. CEO Steve Gold noted that joining Optum provides the opportunity to align primary care capitation models with behavioral health, experiment with innovative care arrangements, and ultimately reduce the total cost of care while improving patient outcomes. Gold emphasized that primary care collaboration is a key part of their strategy to deliver better outcomes and lower costs.
Benefits of a Comprehensive Care Ecosystem
Organizations like Optum, which operate both payer and provider services, can reduce competition for resources and create a more cohesive approach to patient care. Brengard explains, “You have to put yourself in the position to look at the whole patient and figure out, ‘How do I share that overall savings as a team?’ When you start to split the pie at the end of the year, it’s going to be a dog fight.”
By centralizing multiple services under one umbrella—including urgent care, specialty care, chronic care management, virtual care, and medication management—providers can deliver a seamless continuum of care. Patients can receive the right services at the right time, with fewer barriers and better follow-through, which ultimately improves outcomes and lowers long-term costs. Primary care collaboration ensures that both behavioral and physical health providers work together to optimize patient care, rather than functioning in silos.
Refresh Health’s approach also highlights the importance of immediacy in care. Gold points out, “When someone goes into care and fills out the GAD[-7] or whatever it is that they are using to determine mental health status, it would be nice if right there was a therapist because that’s your chance and you may not get that chance again.” Integrating care at the point of need increases the likelihood that patients will engage in treatment, address mental health concerns, and prevent the escalation of chronic or acute conditions, demonstrating the practical impact of primary care collaboration.
Looking Ahead: The Future of Collaborative Care
As value-based care continues to evolve, the integration of primary care and behavioral health appears to be the logical next step. Organizations that successfully combine services are likely to see improved patient outcomes, lower healthcare costs, and higher patient satisfaction. Partnerships between primary care operators and behavioral health providers will be critical, especially for high-acuity patients who face complex physical and mental health challenges.
The experiences of Mindpath Health, BayMark Health Services, and Refresh Health illustrate the promise of this approach. While operational, financial, and patient preference challenges remain, these organizations show that with thoughtful planning and collaboration, holistic care can become a practical reality. Primary care collaboration is not just a trend—it’s the future of delivering effective, patient-centered, value-based care.
