Defining Behavioral Health Integration in Advanced Primary Care

A new CQC issue brief synthesizes insights from national and California stakeholders to clarify what behavioral health integration looks like in practice to better support statewide investment and widespread adoption.

Advanced primary care is California’s standard of care, placing patients at the center of every interaction and delivering high-quality care through patient-centered, results-oriented measures. Behavioral health integration is an essential attribute of high-performing primary care practices, where care teams address patients’ physical, behavioral and social needs in a coordinated way.

While there is broad agreement across stakeholders on the importance of behavioral health integration, a key barrier to widespread adoption in California has been a lack of consensus on how it should be defined in practice.

Behavioral Health Integration is Advanced Primary Care

The California Quality Collaborative (CQC) works alongside providers, payers, purchasers and the state to advance behavioral health integration through its Behavioral Health Integration (BHI) Initiative, which includes learning collaboratives, multi-payer collective solutions and technical assistance. This work supports primary care practices as they integrate behavioral health services in ways that are practical, sustainable and responsive to patient needs.

Through this work CQC has observed that a lack of statewide consensus on how BHI is defined and interpreted has made it challenging to incentivize and sustain the clinical work. To address this gap, CQC released an issue brief, Aligning for Impact: A Shared Definition and Multi-Stakeholder Insights on Behavioral Health Integration in California. The paper synthesizes insights from more than 20 key informants across California to clarify what BHI means in practice, and lessons around multi-stakeholder engagement supporting BHI from Colorado, Pennsylvania, Texas and Virginia.

Key Themes from Stakeholder Perspectives

Across interviews with health plans, provider organizations, state agencies and policy leaders, several themes emerged:

1. Behavioral health integration is part of advanced primary care.
   Stakeholders consistently emphasized that behavioral health services, such as screening, diagnosis and treatment for conditions like depression, anxiety and substance use, are fundamental components of comprehensive primary care.
2. Shared definitions matter.
   Without common language and expectations, efforts to advance integration risk fragmentation. By embedding the definition in payment models, regulatory frameworks and implementation programs, California can accelerate consistent, scalable and sustainable integration of behavioral health into primary care to advance whole-person care statewide.
3. Multi-stakeholder alignment is essential.
   No single group can advance behavioral health integration alone. Progress depends on coordination across multiple health care stakeholders and prioritization of their shared goals.

Explore the full issue brief.

The State of Integration: BHI Health Care Leadership Summit

CQC will host the BHI Health Care Leadership Summit September 16-17 in San Diego, convening health care leaders from across the delivery system to advance integration of behavioral health into primary care and move from shared understanding to concrete, statewide action. Be part of the Leadership Summit.