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

Published December 2021

The Psychiatric Services Editor’s Choice provides essential curated collections from recent issues of Psychiatric Services.  Each month, Editor Lisa Dixon and the Early Career Psychiatrist Advisory Committee offer a curated collection from the rich resource of articles published in the journal. Updates will focus on one area, summarizing for the researcher, clinician, and policy analyst the latest information and seminal research with links to specific content from Psychiatric Services.

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.

Please note that not all articles in this curated collection are available without a subscription. For access, learn about subscribing to Psychiatric Services.


The Learning Curve After Implementation of Collaborative Care in a State Mental Health Integration Program
Andrew D. Carlo, M.D., Philip J. Jeng, M.S., Yuhua Bao, Ph.D., Jürgen Unützer, M.D., M.P.H.
2019, Volume 70, Issue 2, pp. 139–142

Implementing the Collaborative Chronic Care Model in Mental Health Clinics: Achieving and Sustaining Clinical Effects
Mark S. Bauer, M.D., Kelly Stolzmann, M.S., Christopher J. Miller, Ph.D., Bo Kim, Ph.D., Samantha L. Connolly, Ph.D., Robert Lew, Ph.D.
2021, Volume 72, Issue 5, pp. 586–589

Designing an Academic-Community Telepsychiatry Partnership to Provide Inpatient and Outpatient Services in a Critical Access Hospital
Ryan J. Kimmel, M.D., Matthew D. Iles-Shih, M.D., M.P.H., Anna Ratzliff, M.D., Ph.D., Cara Towle, R.N., M.S.N.
2019, Volume 70, Issue 8, pp. 744–746

Impact of the COVID-19 Pandemic on Primary Care–Mental Health Integration Services in the VA Health System
Brittany L. Cornwell, M.P.H., Benjamin R. Szymanski, Ph.D., M.P.H., John F. McCarthy, Ph.D., M.P.H.
2021, Volume 72, Issue 8, pp. 972–973

Structural Components of Integrated Behavioral Health Care: A Comparison of National Programs
Matthew L. Goldman, M.D., M.S., Deborah M. Scharf, Ph.D., C.Psych., Jonathan D. Brown, Ph.D., M.H.S., Sarah H. Scholle, M.P.H., Dr.P.H., Harold A. Pincus, M.D.
Published online 9 Sep 2021

Integrating Behavioral Health and Serious Illness Care in a Post–COVID-19 Environment
Daniel Shalev, M.D., Brigitta Spaeth-Rublee, M.A., Stephanie Cheung, M.D., Jon A. Levenson, M.D., Harold Alan Pincus, M.D.
2021, Volume 72, Issue 12, pp. 1467–1470

Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program
Emily S. Miller, M.D., M.P.H., William A. Grobman, M.D., M.B.A., Jody D. Ciolino, Ph.D., Katelyn Zumpf, M.S., Allie Sakowicz, M.S., Jacqueline Gollan, Ph.D., Katherine L. Wisner, M.D., M.S.
2021, Volume 72, Issue 11, pp. 1268–1275

Assessing the Impact of Different Depression Treatment Success Metrics on Organizational Performance
Andrew D. Carlo, M.D., M.P.H., Gary Chan, Ph.D., Robert F. Arao, M.P.H., Melinda A. Vredevoogd, M.S., John C. Fortney, Ph.D., Diane M. Powers, M.A., M.B.A., Joan E. Russo, Ph.D., Jürgen Unützer, M.D., M.P.H.
2021, Volume 72, Issue 7, pp. 830–834

How a Health Center Eliminated the Waiting List for Psychiatric Services
Shannon Kinnan, M.D., Margaret R. Emerson, D.N.P., A.P.R.N., John Kern, M.D., Anna Ratzliff, M.D., Ph.D.
2019, Volume 70, Issue 12, pp. 1176–1179

Best Practices for Systematic Case Review in Collaborative Care
Amy M. Bauer, M.D., M.S., Mark D. Williams, M.D., Anna Ratzliff, M.D., Ph.D., Jürgen Unützer, M.D., M.P.H.
2019, Volume 70, Issue 11, pp. 1064–1067

Recommendations for Integrated Systems and Services for People With Co-occurring Mental Health and Substance Use Conditions
Kenneth Minkoff, M.D., and Nancy H. Covell, Ph.D.
Published online 13 Oct 2021

A Continuum-Based Framework as a Practice Assessment Tool for Integration of General Health in Behavioral Health Care
Ekaterina Smali, M.P.A., M.P.H., Rachel M. Talley, M.D., Matthew L. Goldman, M.D., M.S., Harold Alan Pincus, M.D., David Woodlock, M.S., Henry Chung, M.D.
Published online 24 Sep 2021

Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare
Leah M. Marcotte, M.D., Ashok Reddy, M.D., M.Sc., Lingmei Zhou, M.S., Anna Razliff, M.D., Ph.D., Jürgen Unützer, M.D., M.P.H., Denise Chang, M.D., Joshua M. Liao, M.D., M.Sc.
2021, Volume 72, Issue 7, pp. 822–825

Sustaining the Collaborative Care Model (CoCM): Billing Newly Available CoCM CPT Codes in an Academic Primary Care System
Andrew D. Carlo, M.D., M.P.H., Lauren Drake, L.I.C.S.W., Anna D. H. Ratzliff, M.D., Ph.D., Denise Chang, M.D., Jürgen Unützer, M.D., M.P.H.
2020, Volume 71, Issue 9, pp. 972–974

Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan
Amy M. Kilbourne, Ph.D., M.P.H., Katherine M. Prenovost, Ph.D., Celeste Liebrecht, L.M.S.W., Daniel Eisenberg, Ph.D., Hyungjin Myra Kim, Sc.D., Hyong Un, M.D., Mark S. Bauer, M.D.
2019, Volume 70, Issue 3, pp. 219–224

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