Behavioral Health

Behavioral health is an essential component of high-quality, patient-centered care, as mental health and substance use concerns directly impact patients’ overall well-being and physical health outcomes. Through its behavioral health integration programs, CQC is helping primary care providers address these needs alongside physical health, fortifying primary care to deliver equitable, whole-person care. Although three out of four primary care visits in California include a mental health concern, many patients are unable to access the treatment they need due to provider shortages, fragmented care and limited screening. Data shows that only 33% of patients are asked about mental health symptoms during medical visits, and even fewer receive the treatment they need.

CQC’s Behavioral Health Integration Initiative is bridging these gaps through evidence-based models that enhance screening, expand access to care and equip primary care teams to meet the comprehensive needs of their patients. Current programs incentivize screenings, offer targeted training and leverage patient-reported data to address critical access issues across the state. By aligning incentives and integrating behavioral health services, CQC is creating sustainable pathways to improve outcomes and ensure that underserved populations receive the mental health care they deserve.

Advanced Primary Care

For over a decade, CQC has led initiatives to transform primary care into a foundation for healthier, cost-effective outcomes across California. Through its work with diverse stakeholders — including health plans, purchasers and providers — CQC has pioneered the development of the Advanced Primary Care model, which places patients at the center of every interaction and defines high-quality care through patient-centered, results-oriented measures.

By establishing shared attributes and measures, CQC enables payers, providers and health care purchasers to identify, incentivize and expand high-performing practices. Building on a statewide practice transformation initiative funded by the Centers for Medicare and Medicaid Services, CQC’s definition of Advanced Primary Care now serves as a blueprint for quality improvement nationwide. Current programs and initiatives demonstrate how coordinated efforts can standardize high-value primary care, aligning financial incentives to improve access, patient outcomes and cost efficiency.

Publications

Intensive Outpatient Care Program

Dates Active: 2012-2015

The Intensive Outpatient Care Program (IOCP) was a three-year initiative led by the California Quality Collaborative from 2012 to 2015 through a CMS Innovation Center grant. The program supported 23 participating provider organizations serving over 15,000 Medicare beneficiaries across Arizona, California, Idaho, Nevada, and Washington in adopting a patient-centered, team-based care model to manage high-risk, medically complex patients. IOCP focused on improving clinical outcomes, enhancing patient experience, and reducing the utilization of high-cost care services such as emergency department visits and hospitalizations. The program enrolled over 9,500 patients, particularly targeting those whose outcomes could be significantly improved through enhanced care coordination.

Program Overview

IOCP provided a comprehensive framework for integrating intensive outpatient care into participating healthcare organizations’ existing services. Key elements of the program included:

• Multidisciplinary Team-Based Approach. Central to the IOCP model was a care coordinator who served as the primary link between patients and their care teams, including primary care, specialty services and community resources.
• Comprehensive Care Coordination. The program emphasized coordination of medical, behavioral and psychosocial care tailored to the needs of patients with chronic illnesses and multiple comorbidities.
• Patient-Centered Care Planning. Care coordinators worked with patients to develop individualized care plans that aligned with their personal health goals and needs.
• Support for Self-Management. Patients were provided with tools and resources to manage their conditions effectively, reducing dependency on emergency and inpatient services.

Participant Support 

IOCP participants received:

• Funding and Grants. Financial support to implement and sustain the intensive outpatient care model.
• Training and Curriculum. Access to a comprehensive training curriculum focusing on patient-centered care, care coordination and self-management strategies.
• Peer Learning Opportunities. Regular learning sessions and workshops to share insights, strategies and best practices among peers.
• Technical Assistance. Ongoing support from CQC and its partners, including expertise in care model design, data analytics and quality improvement.

Program Outcomes

IOCP achieved significant improvements in both patient outcomes and health care utilization:

• Reduction in Depression Symptoms. The program reported a 33% improvement in average PHQ-9 scores among participants, indicating better management of depression.
• Reduction in Cost of Care. 21% reduction in cost of care for high-risk patients enrolled for at least nine months.
• Increased Patient Activation. 3.6% patient engagement increase of patients advancing to a higher level of activation.
• Health Status Improvement. Participants showed a 3.4% increase in mental health composite scores and a 4.1% increase in physical health composite scores, according to the Health Status Survey (VR-12) results.

Funding

IOCP was made possible by the generous support of the Centers for Medicare & Medicaid Services.

California Medicare Collaborative

California’s over-65 population is diversifying and growing faster than any other age group. By 2030, it will represent a quarter of the population, which means addressing their unique health and long-term care needs will become critical, requiring creative solutioning for the delivery ecosystem. Medicare beneficiaries tend to have chronic conditions, need a variety of providers and services and may experience daily living challenges, leading to difficulty navigating a complex system of medical and nonmedical services when seeking to live a healthy, safe life at home. Medicare-only individuals are often forgotten in their struggles to finance and access the services and support they need across the health care, behavioral health, and long term services and supports delivery systems.

To address this need, the California Quality Collaborative (CQC), The SCAN Foundation, Archstone Foundation, Gary and Mary West Foundation and Department of Health Care Services Office of Medicare Innovation and Integration, will launch the California Medicare Collaborative, a one-year stakeholder alignment effort beginning in March 2024, dedicated to improving care across the spectrum of Medicare enrollees, including duals, non-duals and those in traditional Medicare and Medicare Advantage programs.

Goals and Areas of Focus

The collaborative will focus on the following four areas:

• Cognitive and behavioral health
• Chronic illness management and care coordination
• Support consumer choice in a confusing market
• Access, equity and disparities in care

CQC’s goal is to gain consensus within each focus area by the end of 2024 on opportunities for action that can be achieved through alignment and partnerships among California delivery system stakeholders and to secure commitment from these stakeholders to support implementation of those action steps following the close of the collaborative.

Participants

CQC, along with the Department of Health Care Services’ Office of Medicare Innovation and Integration (OMII) and our funders, is seeking to involve a wide range of stakeholders. This diverse representation will ensure that a range of organizational perspectives influencing Medicare care delivery in California are considered. Participants will have the opportunity to forge valuable connections with peers and actively contribute to shaping the future direction and strategy of California’s Medicare system.

Support

This program is made possible thanks to the support of The SCAN Foundation, the Archstone Foundation and the Gary and Mary West Foundation, in collaboration with the Department of Health Care Services Office of Medicare Innovation and Integration.

Comprehensive Maternity Care Workgroup

The United States has the highest rate of maternal mortality among wealthy nations. Moreover, women of color are more likely than white women to die from complications of childbirth, and access to maternity care is decreasing as maternity care deserts – counties with limited or no maternity care – become increasingly common. Employers pay for more than half of the births in the U.S. and can play a significant role in impacting maternal and infant health outcomes on behalf of workers and their family members.

PBGH’s Comprehensive Maternity Care Workgroup, launched in summer 2022 and co-chaired by Qualcomm Incorporated and Walmart, brings together employers and public purchasers to achieve high-quality, affordable and equitable health care for mothers and babies.

The workgroup, in partnership with other stakeholders and subject-matter experts, has developed tools to advance that goal, including a shared standard to define Comprehensive Maternity Care, a purchaser Priority Maternity Measure Set to ensure accountability and transparency and the PBGH Comprehensive Maternity Care Common Purchasing Agreement, which provides benefit design and purchasing recommendations for employers and public purchasers, health plans and providers. These tools are intended to help ensure public and private purchasers are purchasing accessible, high quality and equitable maternal care for their workers and family members.

For questions regarding PBGH’s maternal health and birth equity work or opportunities to partner, please contact Randa Deaton at rdeaton@pbgh.org.

Behavioral Health Integration – Children and Youth Collaborative Learning Exchange

Launched October 2024, the Behavioral Health Integration – Children and Youth Collaborative Learning Exchange is a nine-month learning collaborative that brings together organizations experienced in integrating behavioral health services into primary care for children and youth. ​

Collaborative Objectives​

By July 2025, the collaborative aims to have improved behavioral health integration for children and youth served by leading provider organizations by:​

• Showcasing successful practices and highlighting solutions through a vibrant network of peer organizations​
• Sprouting adoption of new solutions addressing real-world challenges that improve the delivery of pediatric and adolescent integrated behavioral health care ​ ​
• Sharing best practices through a public toolkit that synthesizes collaborative participants’ recommendations, experience and contributions to the field

Participating Organizations

• Alliance Medical Center — rural Federally Qualifying Health Center (FQHC) in northern Sonoma County
• Altamed Health Services — FQHC in Los Angeles and Orange Counties
• Children’s Hospital of Orange County — health system providing inpatient and outpatient services across Southern California
• LifeLong Medical Care — FQHC with locations in Alameda and Contra Costa counties
• Providence Medical Group (Northern California) — network spanning Sonoma, Napa and Humboldt counties
• San Francisco Health Network — multi-site FQHC and part of San Francisco’s public health system
• Chinese Hospital — (learning participant) hospital system with locations in San Francisco and Daly City

Organizations participating in the collaborative will receive:

• Funding of up to $7,500 over the course of the collaborative to support the advancement of behavioral health integration
• Facilitated monthly peer meetings that promote sharing and learning from a dynamic network of peer health care organizations

Technical Assistance Partner

CQC is partnering with Rady Children’s Hospital-San Diego for the Behavioral Health Integration – Children and Youth Collaborative Learning Exchange technical assistance program. Rady Children’s is the largest provider of comprehensive pediatric medical services in the San Diego region and a leader in integrated behavioral health. The hospital launched a primary care behavioral/mental health integration program in 2020 that provides evidence-based mental health care through embedding mental health clinicians in pediatric primary care practices for easy, same-day access.

Support

CQC’s Behavioral Health Integration Initiative is made possible thanks to the generous support of the Centene Corporation.