Know Before You Go Guide for Financing Integrated Behavioral Health

About The Guide

This guide sets the stage for developing and tailoring a financing strategy for integrated behavioral health (IBH) by establishing a shared definition of its value and outlining the cultural shifts and core operations needed to maximize that value.

IBH is first and foremost a commitment to providing the highest standard of patient care within a primary care setting. You can integrate behavioral health and primary care while remaining profitable overall.¹

The Value of Integrated Behavioral Health: A Shared Mindset

The financial challenges of moving to IBH care can seem daunting. Fortunately, by braiding different strands of funding, the transition can be both possible and sustainable. However, the greatest financial return of an integrated program often manifests downstream.² While the behavioral health service line itself may not always show a direct profit in a traditional financial model,³ its value is captured through improved management of chronic conditions, reduced administrative burden on primary care providers, and lower total cost of care.¹

Transitioning to integrated care requires moving away from siloed thinking and viewing behavioral health integration as a long-term investment in a practice or system’s value, rather than a standalone, self-sustaining profit center.

Tab Label	Siloed Thinking	Integrated Thinking	Value Added
Profit	"Will it pay for itself or break even?"	"How will we pay for it with external and internal funds?"	A braided funding strategy can cross-subsidize costs within an organization to pay for behavioral health integration.⁴
Revenue	"How much billing code revenue will we generate?"	"How much will we improve patient health, and what savings will that generate?"	IBH can create savings by helping manage complex conditions and preventing expensive, unnecessary emergency care.¹
Patient Volume	"How many patients will the behavioral health provider(s) see each day?"	"How much time will the behavioral health provider(s) save the primary care provider(s)?"	A warm handoff from a primary care provider to a behavioral health provider can increase treatment "buy-in" and reduce no-show rates for follow-ups.^5–9 When behavioral health providers handle crises or complex consults, they can free up primary care provider time. This additional time allows primary care providers to see more patients, generating more revenue.^10–12
Staffing Costs	"Will we be able to afford the salary and fringe expenses?"	"Will we be able to afford the cost of primary care provider turnover?"	Integration can support the clinical team. Both behavioral health and primary care providers in integrated practices report higher career satisfaction.^13,14

Necessary Cultural Shifts for Financing Integrated Behavioral Health

This section outlines the essential cultural shifts required to achieve financial sustainability in IBH. These shifts emphasize the transition from traditional, isolated billing practices toward a unified model in which every team member—from administrative staff to clinicians—plays a role in demonstrating value. These principles provide the framework for the operational strategies discussed throughout this guide and are designed to help your practice or system capture revenue and improve patient outcomes, regardless of your current or planned financial strategy.

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Cultural Shift #1: Everyone Understands Their Role

Sustainability depends on every staff member understanding how their role contributes to the value of IBH.¹⁵ These contributions range from generating immediate revenue through the proper use of billing codes in fee-for-service (FFS) payment models to driving positive health outcomes that generate downstream savings. In value-based payment arrangements, this work can further translate into revenue from shared savings and pay-for-performance incentives.

How can you make this shift?

Assess Every Component of the Practice: Use a comprehensive readiness assessment to evaluate all operational areas. Behavioral health integration can break down at the front desk or in the billing department just as easily as in the exam room.¹⁶
Provide Training for Staff, Clinicians, and Billers: Most clinicians, whether behavioral health or primary care, lack the skills needed to work in integrated care teams.¹⁷ Maintain a consistent schedule of multidisciplinary training to promote practice- or system-wide alignment and ensure every patient touchpoint reinforces the clinical and financial goals of integrated care.

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Cultural Shift #2: Administrative, Clinical, and Billing Workflows Are Unified

When administrative, clinical, and billing workflows are siloed, issues during scheduling or at check-in can prevent access to integrated care services. For example, billers may be unaware of the specific integrated care services being provided or lack the required documentation (e.g., time spent) to code them accurately. This lack of coordination can lead to inaccurate or incomplete data and fragmented care, ultimately depriving practices, health systems, and patients of the improvements in care quality and outcomes that integration can deliver, as well as the revenue and savings integration can generate. Conversely, when workflows are fully synchronized, a practice or health system can facilitate seamless connections to integrated care services and accurately capture the financial and clinical value those services create.¹⁸

How can you make this shift?

Standardize Administrative and Clinical Documentation: Create and use electronic health record (EHR) templates that prompt clinicians to record essential billing elements (e.g., assessment scores, duration, or care coordination) and ensure administrative staff capture necessary consents and authorizations at the point of entry.
Establish a Continuous Feedback Loop: Use huddles and real-time communication to alert front-desk staff and billers to integrated interventions as they happen and link accurate coding and efficient administrative processing to tangible patient outcomes.

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Cultural Shift #3: Data Demonstrates Value

Traditional FFS payments typically do not cover the full cost of the multidisciplinary team and administrative overhead required for integrated care. Sustainable integration often requires a shift from volume-based revenue generation toward demonstrating broader clinical and financial value.¹⁹ Mastery of traditional FFS billing can serve as the foundation for this shift, providing the data necessary to build a scalable model and transition confidently into capitated or value-based payment models.

In a capitated environment—where the primary goal is to manage a global budget—success depends on demonstrating that IBH care reduces total care costs. Consequently, outcome and performance data become the decisive factors in financial sustainability. To thrive in value-based payment arrangements, practices and health systems must explicitly link integration to key metrics (e.g., depression screenings or post hospitalization follow-up care).

How can you make this shift?

Audit Current Coding Practices: Identify underutilized billing codes specifically designed for or relevant to behavioral health integration services. The auditing process helps to ensure that when integration services are performed, the associated revenue is captured.
Establish Financial and Clinical Baselines: Analyze your current margins for high-risk patient populations prior to launching or expanding IBH. Quantifying the cost of doing nothing—such as the high expense of untreated depression in diabetic patients—allows for a more accurate measurement of the financial and clinical value provided by integration.
Invest in Data-Capable Staff and Technology: Achieve and maintain the administrative capacity and EHR functionality required to track quality metrics. Consistently capturing clean data is key to demonstrating value to payers and partners.
Align Metrics with Payer Incentives: Identify the performance markers used in alternative payment models and track those that trigger shared savings or pay-for-performance incentive bonuses.

Implement these Shifts with the Integration Playbook

The AHRQ Academy Integration Playbook provides additional guidance and resources for implementing these cultural shifts, as well as other aspects of behavioral health integration.

Visit the Integration Playbook

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NIAC Note: The Brain is Not Separate from the Body

Imagine if a health system maintained separate billing, records, and budgets for cardiology. It would be seen as a failure of care. Treat the behavioral health providers on your care team like any other medical provider—not a separate entity. When you isolate behavioral health data or budgets, you inhibit team function and decrease the overall value of behavioral health integration. As you embark on or continue your integrated behavioral health journey, work toward the unification of mind and body.

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About the Toolkit

While this "Know Before You Go" guide establishes the foundational mindset for financing IBH, the toolkit provides practical strategies, tools, and resources for building your financing strategy. The toolkit is designed to be modular, enabling you to tailor your financial strategy to your unique payer mix, setting types, and patient demographics. Use the navigation menu on the left to identify the information most relevant to your practice or health system.

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Additional Resources

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Readiness Assessments

Agency for Healthcare Research and Quality: Integration Self-Assessment Checklist
National Council for Mental Wellbeing: Integration Practice Assessment Tool (IPAT) (PDF – 288 KB)
American Academy of Pediatrics: Mental Health Practice Readiness Inventory (PDF – 278 KB)

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Training Resources

University of Washington AIMS Center: Resource Library for Integrated Behavioral Health Care
The REACH Institute: Mental Health Training
Centers for Disease Control and Prevention: Addiction Medicine Toolkit
PCSS-Medications for Opioid Use Disorder (MOUD): MOUD Education & Training Resources
PCSS-Medications for Alcohol Use Disorder (MAUD): MAUD Education Resources
Centers for Medicare & Medicaid Services: Medicare Learning Network Booklet: Behavioral Health Integration Services (PDF – 3 MB)
American Medical Association: Behavioral Health Billing & Coding 101: How to Get Paid
National Council for Mental Wellbeing: Billing Effectively for Integrated Behavioral Health Services

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Workflow Resources

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Clinical and Financial Data Resources

Assistant Secretary for Technology Policy: Health IT Playbook
United States Core Data for Interoperability: Comprehensive Care Use Case
American Medical Association: Behavioral Health Opportunities in Value-Based Care: Guidance for Physician Practices (PDF – 580 KB)
American Medical Association: Value-Based Care: Physician-Led Models to Achieve the Quadruple Aim
Colorado University Anschutz School of Medicine: Developing Financial Sustainability for Integrated Behavioral Health Practices (PDF – 5 MB)
University of Washington: The Value-Based Toolkit for Primary Care (PDF – 4 MB)

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1. Yuhas M, Raines L, Glastra J, Wells L, Bowman MB, Middlebrook BA, et al. CoCM Total Healthcare Costs Issue Brief, 2025 [Internet]. Hockessin, DE: The Bowman Family Foundation; 2025 [cited 2026 Feb 3]. Available from: https://concerthealth.com/hubfs/00_Assets/CoCM%20Total%20Healthcare%20Costs%20Issue%20Brief%202025.pdf

2. Ross KM, Gilchrist EC, Melek SP, Gordon PD, Ruland SL, Miller BF. Cost savings associated with an alternative payment model for integrating behavioral health in primary care. Transl Behav Med. 2019 Mar 1;9(2):274-281.

3. Basu S, Landon BE, Williams JW, Bitton A, Song Z, Phillips RS. Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices. J GEN INTERN MED. 2017 Dec 1;32(12):1330-1341.

4. Ma KPK, Mollis BL, Rolfes J, Au M, Crocker A, Scholle SH, et al. Payment strategies for behavioral health integration in hospital-affiliated and non-hospital-affiliated primary care practices. Transl Behav Med. 2022 Jul 26;12(8):878-883.

5. Young ND, Mathews BL, Pan AY, Herndon JL, Bleck AA, Takala CR. Warm Handoff, or Cold Shoulder? An Analysis of Handoffs for Primary Care Behavioral Health Consultation on Patient Engagement and Systems Utilization. Clinical Practice in Pediatric Psychology. 2020 Sep 1;8(3):241-246.

6. Tobin ET, DePascale E, Berezin MN, Evitts M, Thomas E, Nair A, et al. Brief introductions to increase engagement with integrated psychology services in primary care. Families, Systems, & Health. 2025.

7. Mitchell D, Olson A, Randolph N. The impact of warm handoffs on patient engagement with behavioral health services in primary care. Journal of Rural Mental Health. 2022;46(2):82-87.

8. Fountaine AR, Ivar MM, Lutes LD. Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study. JMIR Formative Research. 2023 Jun 20;7(1):e40274.

9. Taylor RM, Minkovitz CS. Warm Handoffs for Improving Client Receipt of Services: A Systematic Review. Matern Child Health J. 2021 Apr 1;25(4):528-541.

10. Riley AR, Paternostro JK, Walker BL, Wagner DV. The Impact of Behavioral Health Consultations on Medical Encounter Duration in Pediatric Primary Care: A Retrospective Match-Controlled Study. Fam Syst Health. 2019 Jun;37(2):162-166.

11. Gouge N, Polaha J, Rogers R, Harden A. Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost. South Med J. 2016 Dec 1;109(12):774-780.

12. Evans TM, Valleley RJ, Haack MK, Thorson R, Joseph J. Physician “Costs” in Providing Behavioral Health in Primary Care - Tawny Meadows, Mary Kelly Haack, Ryan Thorson, Joseph Evans, 2011. Clinical Pediatrics [Internet]. 2010 Dec 30 [cited 2026 Feb 3]. Available from: https://journals.sagepub.com/doi/abs/10.1177/0009922810390676

13. Holmes A, Chang YP. Effect of mental health collaborative care models on primary care provider outcomes: an integrative review. Fam Pract. 2022 Oct 1;39(5):964-970.

14. Zubatsky M, Runyan C, Gulotta S, Knight JR, Pettinelli JD. Burnout among behavioral health providers in integrated care settings. Families, Systems, & Health. 2020;38(1):74-82.

15. Making Integration Work: Key Elements for Effective Partnerships Between Physical and Behavioral Health Organizations in Medicaid.

16. Gunn R, Davis MM, Hall J, Heintzman J, Muench J, Smeds B, et al. Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care. J Am Board Fam Med. 2015 Sep 1;28(Supplement 1):S52-S62.

17. Hall J, Cohen DJ, Davis M, Gunn R, Blount A, Pollack DA, et al. Preparing the Workforce for Behavioral Health and Primary Care Integration. J Am Board Fam Med. 2015 Sep 1;28(Supplement 1):S41-S51.

18. Davis MM, Gunn R, Cifuentes M, Khatri P, Hall J, Gilchrist E, et al. Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and Primary Care. The Journal of Ambulatory Care Management. 2019 Mar;42(1):51.

19. Shmerling AC, Gold SB, Gilchrist EC, Miller BF. Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions. Transl Behav Med. 2020 Aug 7;10(3):648-656.

Know Before You Go Guide for Financing Integrated Behavioral Health

About The Guide

The Value of Integrated Behavioral Health: A Shared Mindset

Necessary Cultural Shifts for Financing Integrated Behavioral Health

Cultural Shift #1: Everyone Understands Their Role

Cultural Shift #2: Administrative, Clinical, and Billing Workflows Are Unified

Cultural Shift #3: Data Demonstrates Value

NIAC Note: The Brain is Not Separate from the Body

About the Toolkit

Additional Resources

References