While some practices quickly transition to fully integrated models like Collaborative Care, most benefit from a phased approach. This gradual progression allows practices to build infrastructure, adapt workflows, and implement core elements of integrated care, ultimately achieving comprehensive care for both physical and mental health needs.

Further reading: Implementation of Behavioral Health Integration in Small Primary Care Settings: Lessons Learned and Future Directions Goldman ML, Smali E, Richkin T, Pincus HA, Chung H. Community Ment Health J. 2022 Jan;58(1):136-144. doi: 10.1007/s10597-021-00802-z. Epub 2021 Feb 27. PMID: 33638059.

Strategies for Integrated Care

• Screening, Identification, and Education
  • Routine Screening and Connection to Treatment: Implement measurement-based tools to identify conditions like depression, anxiety, and substance use disorders and link to internal or external behavioral health resources.
  • Training and Education: Equip primary care providers to recognize mental health symptoms and understand appropriate treatment and referral pathways.
• Coordination, Co-Location, and E-Consults
  • Behavioral Health Coordination: Employ care managers to streamline referrals and enhance communication across providers.
  • Co-Located Behavioral Health Specialists: Introduce behavioral health specialists within the practice for support and interventions.
  • E-Consults: Enable electronic consultations with psychiatric specialists, providing timely expert guidance to primary care providers managing complex cases.
• Embedded Behavioral Health and Shared Care
  • Embedded Behavioral Health Providers: Integrate behavioral health clinicians into the primary care team to allow real-time collaboration and coordinated care plans. The most common model for this is called Primary Care Behavioral Health (PCBH).
  • Collaborative Care Model (CoCM): Establish a comprehensive system with care managers, psychiatric consultants, and primary care providers working together. Population-level screening is critical to ensure all patients with psychiatric needs are identified, rather than relying solely on primary care referrals, which can miss patients who need care.

Building Blocks for Progress

• Leadership and Buy-In: Establish commitment from practice leaders to prioritize integrated care and reinforce its importance through ongoing education.
• Infrastructure Investment: Develop the physical and technological infrastructure—such as EHR modifications and telehealth capabilities—needed to support integrated care workflows.

Technology as a Key Enabler in Integrated Care

Screening and Risk Stratification

Technology can facilitate screening for behavioral health needs by offering tools synchronously during visits or asynchronously through patient portals. Automated screening enables providers to:

• Identify patients appropriate for Collaborative Care and other integrated care strategies.
• Provide psychoeducation or digital resilience support for patients across the acuity spectrum.
• Flag high-acuity patients for referral to intensive outpatient or inpatient behavioral health care when safety is a concern.

Clinical Decision Support and Personalized Patient Interventions

Technology enhances clinical decision-making and patient engagement by:

• Synthesizing data from EHRs and claims data (when available) to supplement standardized scales, providing clinicians with comprehensive insights and personalized support recommendations.
• Offering digital, condition-specific Cognitive Behavioral Therapy (CBT) and other interventions, allowing patients to engage in therapeutic activities between appointments.
• Standardizing care interventions in integrated settings, ensuring that patients consistently receive high-quality, evidence-based care.

Further Reading

American Medical Association's August 2022 report, Accelerating and Enhancing Behavioral Health Integration Through Digitally Enabled Care: Opportunities and Challenges.