Financing and Sustaining Integrated Behavioral Health in Primary Care Settings Toolkit

Purpose

This interactive toolkit was developed to help primary care providers and practices build and maintain financially sustainable integrated behavioral health (IBH) models. It establishes a shared definition of value for IBH and highlights the cultural shifts and core operations needed to maximize it. It outlines the funding streams available for behavioral health integration and how to navigate the transition from volume- to value-based payment. The toolkit also provides tools and benchmarks for calculating start-up and implementation costs, potential offsets and savings, and revenue, and offers financing considerations and strategies tailored by payer, setting, and patient population.

Navigating the Toolkit

This toolkit is designed to be flexible. You are encouraged to jump between sections to find the specific topics and information that meet you where you are in your behavioral health integration journey or align with your payer mix, setting, and patient populations.

Know Before You Go Guide Plan Your IBH Funding Mix Calculate Your IBH Costs and Value Tailor Your IBH Financing Strategy View Examples of Sustainable IBH Financial Strategies

Intended Audience and Users

This product is intended for health care leaders, including C-suite executives, practice managers, medical directors, finance directors, primary care providers, behavioral health providers, administrative staff, and anyone with an interest in financing and sustaining IBH in primary care settings.

Use this toolkit to:

Champion the Value of IBH:

Align leadership, care teams, and staff on a shared definition of value and translate clinical data and pro forma projections into compelling narratives to justify long-term investment in IBH.

Overcome Operational Barriers:

Navigate the cultural shifts and core operational changes—such as documentation, compliance, and billing workflows—necessary to sustain integrated models.

Create a Sustainable Financing Strategy:

Identify and tailor strategies for cross-subsidizing funds, securing grants and gifts, and negotiating and entering payer arrangements that ensure financial sustainability for IBH.

Toolkit Quick Links

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Authors

Monique Thornton, MPH — Chief Executive Officer, Let’s Talk Public Health
Judith Steinberg, MD, MPH, FACP — Faculty Affiliate of the Harvard Medical School Center for Primary Care, Boston, MA
Danielle Durant, PhD, MS, MS, MBA — Principal Research Associate, Westat

Other Contributors

Annaka Paradis, ScM — Lead Research Associate, Westat
Jodi Polaha, PhD — Director, Institute for Integrated Behavioral Health, East Tennessee State University
Garrett Moran, PhD — Principal, Moran Consulting
Anne Roubal, PhD — Principal Research Associate, Westat

Agency for Healthcare Research and Quality

We thank our colleagues at the Agency for Healthcare Research and Quality for their support, insightful comments, and guidance.

Elisabeth Kato, MD, MR — Medical Officer, Agency for Healthcare Research and Quality

Other Acknowledgements

We thank all members of the National Integration Academy Council who contributed to the review of this product. We also thank Pantheon and the Westat Interactive Design Team for the web design and development. In addition, we thank our colleague Matthew Simpson, MD, MPH, Director of Analytics and Scholarship at Mountain Area Health Education Center, for his support, insightful comments, and guidance.