Integrated Care Refresh, Part 1: Integration of Behavioral Health Into Primary Care

Since publication of the first Editor’s Choice Collection on Integrated Care in 2019, the literature has continued to expand, reflecting a growing interest in and implementation of models to improve high-quality health care and access to it. We refresh this integrated care collection in two parts, the first focusing on integrated behavioral health care, and more specifically the collaborative care model, and the second highlighting innovations in integrated care.

Due to long-standing shortages of specialty mental health providers and deep-seated stigma surrounding mental illness, most behavioral health treatment in the United States has been delivered in the primary medical setting for decades. Usual behavioral health treatment in primary care, however, is challenged by limited resources, competing priorities, short visits, and lack of access to specialty treatment when indicated. The collaborative care model (CoCM) offers a solution through population health principles, technology, and systematic teamwork between the primary medical provider, a specially trained care manager, and a designated psychiatric consultant. CoCM is extensively evidence based, with more than 90 randomized controlled trials demonstrating its efficacy across a variety of populations and treatment settings. Implementation of CoCM also carries with it an opportunity to reduce inequities in behavioral health care by reducing stigma, improving access to care, and monitoring outcomes at the population level so that services can be tailored to address racial, ethnic, linguistic, and socioeconomic disparities.

This collection offers some of the latest research on CoCM that moves along the research-to-practice continuum from clinical trials to implementation, quality improvement, and financial sustainability. Some highlights include strategies to optimize key components of CoCM (e.g., the case review), a longitudinal evaluation of CoCM implementation, and guidance on how to use the novel CoCM billing codes to make the program financially sustainable.