By Lynn Carroll, Chief Operating Officer, HSBlox
LinkedIn: Lynn Carroll
LinkedIn: HSBlox, Inc.
Behavioral health and primary care integration is quickly moving from policy aspiration to expectation.
We’ve long known that behavioral health disorders, including depression, anxiety, substance abuse, and others, can cause poor adherence to care plans and eventually increase utilization. People managing behavioral health conditions alongside similar levels of physical illness often generate nearly three times the healthcare costs of their peers without those conditions, largely because they require more frequent hospitalizations, emergency visits, and other intensive services.
Payers and policymakers are taking note, treating the integration of primary care and behavioral health as a core component of value-based care (VBC). The question for healthcare organizations is no longer whether they should integrate, but how to sustain it.
CMS PC Flex: Raising the stakes
One of the clearest signals comes from the Centers for Medicare and Medicaid Services (CMS). Its ACO Primary Care Flex (PC Flex) model replaces unpredictable fee-for-service billing with steady, prospective payments for primary care. Crucially, the model explicitly supports behavioral health integration.
That design frees practices to invest in services that have long gone unreimbursed — screenings, care coordination, and navigation of social needs — by tying payment to population health instead of individual visits. PC Flex also levels the playing field for safety-net and rural providers by benchmarking payments to county averages, rather than locking them into historically low reimbursements. More dollars flow to high-need communities, where gaps in behavioral health access are most acute.
Commercial payers are moving in the same direction. Humana, Cigna’s Evernorth, and others are embedding behavioral health into value-based arrangements, testing outcome-based contracts, and pushing for consistent standards.
Why financing alone isn’t enough
Fee-for-service payment models were not designed for behavioral health integration. When certain screenings, care coordination, and even telehealth go unreimbursed, providers are left without the resources to build sustainable programs. Funding models like PC Flex and those adopted by payers create new opportunities for integration. But dollars alone won’t solve the problem.
For integration to take hold, organizations need the right digital scaffolding to manage it every day. That means infrastructure for:
- Attribution – clearly identifying patients with overlapping medical and behavioral needs.
- Contracting – structuring agreements across specialists, primary care teams, and community partners.
- Data sharing – moving patient information securely and consistently across care settings.
- Communication – enabling warm handoffs, follow-ups, and patient engagement.
- Performance reporting – producing timely, trusted measures of access, outcomes, and cost trends.
What sustainable integration looks like
When the right payment and infrastructure pieces come together, integration starts to feel standardized. Patients are screened regularly for behavioral health needs and connected quickly to the right levels of support. Primary care physicians and behavioral health providers securely exchange information, so care plans remain consistent.
Community-based organizations addressing housing or food security join the same coordinated network, so patients receive help with the issues that drive behavioral health crises. With clear contracts, data-sharing agreements, and performance reporting in place, these partnerships become part of the system. Patients experience continuity, providers have visibility across the full care journey, and payers gain confidence in their investments.
Sustainability starts with infrastructure
Behavioral health integration is no longer optional. With CMS and commercial payers moving in the same direction, it is rapidly becoming the baseline expectation. The challenge now is how to make integration last.
VBC sustainability depends on building the infrastructure that supports attribution, contracting, data sharing, communication, and performance reporting at scale. The dollars flowing through new payment models must be justified by real improvements in access, equity, and outcomes.
Organizations that invest now will be able to demonstrate the value of integration, expand their roles as trusted partners, and deliver care that patients can rely on. With the right foundation, policy momentum turns into durable change — and behavioral health takes its rightful place at the center of primary care.