Revenue and Savings Considerations

Integrating behavioral health not only improves patient outcomes but also creates financial benefits for primary care settings. These financial benefits are realized through two main mechanisms: increased revenue generated from new billable encounters (in a fee-for-service payment model) and shared savings and incentive payments for improving quality of care, enhancing patient outcomes, and reducing unnecessary acute care utilization (in a value-based payment model). This section outlines the types of savings your practice may realize and strategies for maximizing revenue and savings.

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Revenue-Generating and Cost-Saving Benefits

Fee-for-service billing is the most direct and widely accessible way for primary care settings to generate revenue from integrated behavioral health (IBH). While IBH can also produce cost savings through improved quality, better outcomes, and reduced acute care utilization, these savings are not realized at the practice or provider level unless the practice or provider participates in a value-based payment model. Without value-based arrangements, the financial benefits of cost savings accrue primarily to payers and to larger health systems.

Increased use of behavioral healthcare services: IBH can increase access to and use of behavioral health services (e.g., specialized screenings and brief interventions) in primary care settings, creating new fee-for-service billing opportunities.^1–3
Recovered primary care provider time: 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.^4–8 Additionally, when behavioral health providers manage crises, complex consults, or brief interventions, it reduces the administrative and emotional burden on primary care providers. This capacity gain allows primary care providers to see additional patients, which can increase overall practice throughput and revenue.^9–11
Improved quality of care: IBH can also improve care coordination, patient monitoring, treatment tailoring, and adherence to evidence-based practices, supporting clinical quality and efficiency and creating opportunities for generating revenue when primary care settings participate in value-based payment models that tie payment to quality performance.^12–14
Better patient outcomes: Implementing IBH can lead to increased adherence to treatment, improved management of co-occurring conditions, and improved health outcomes, creating opportunities for incentive payments or performance bonuses when primary care settings participate in value-based payment models.^2,12,15–21
Lower utilization of costly acute care: Effective IBH services can decrease unnecessary emergency department visits and hospitalizations, resulting in lower overall healthcare expenditures and also creating opportunities for financial returns when primary care settings participate under shared savings or risk-bearing value-based payment models.^13,22–24

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Strategies for Maximizing Integrated Behavioral Health Revenue and Savings

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Strategy

Resources

1

Track Avoidable Utilization

Use digital health tools and technologies to track emergency department visits, inpatient stays, and specialty referrals for quality improvement, and to demonstrate improved outcomes and reduced costs to stakeholders and payers to inform negotiations for value-based payment arrangements.

AHRQ: Collect and Use Data for Quality Improvement

AHRQ: Leverage Technology for Integrated Behavioral Health

Assistant Secretary for Technology Policy: Health IT and Health Information Exchange Basics

American Medical Association: EHR Transitions Best Practices for Implementing a New EHR System

2

Optimize Staffing Models

Design staffing models that maximize efficiency, reduce costs, and align workforce capacity with patient demand. When primary care providers and behavioral health professionals share visits and coordinate documentation, practices can bill higher-complexity codes—generating more revenue without increasing workload.

AHRQ: Obtain Behavioral Health Expertise and Build a Culture of Integration

AIMS Center: Collaborative Care Team Building and Workflow Guide (PDF – 261 KB)

3

Optimize Billing and Coding and Implement Continuous Auditing

Train staff to ensure accurate coding for behavioral health screenings, brief interventions, and follow-up care to capture all possible reimbursement opportunities. Implement regular audits of clinical documentation to identify leakage—instances where integrated services were provided but not coded. Establish a feedback loop between billers and clinicians to ensure documentation supports high-complexity codes and time-based behavioral health integration (or BHI) codes.

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

American Medical Association: Behavioral Health Coding Guide

AIMS Center: Basic Coding for Integrated Behavioral Health Care (PDF – 400 KB)

PRISM: CoCM EHR Documentation Templates Universal

American Medical Association: BHI Workflow Guide

4

Proactively Negotiate with Payers to Optimize Reimbursement Rates and Set Up Value-Based Arrangements

Leverage internal and external data during contract negotiations for increased compensation for IBH services.

Position IBH as a driver of quality and cost savings within value-based contracts. Highlight reduced hospitalizations and improved outcomes to earn incentive payments, performance bonuses, and shared savings revenue.

American Medical Association: Behavioral Health Opportunities in Value-Based Care: Guidance for Physician Practices (PDF – 580 KB)

AIMS Center: Quick Guide on Bundled Payments for Behavioral Health Integration Services (PDF – 363 KB)

AIMS Center: Value Based Toolkit for Primary Care (PDF – 4 MB)

American Medical Association: Private Practice: Payor Contracting 101 (PDF – 229 KB)

American Medical Association: Private Practice: Payor Contracting 201

American Medical Association: BHI in Action: Fostering Effective Health Plan-Physician Partnerships

Health Care Payment Learning & Action Network: Alternative Payment Model (APM) Framework

Eugene S. Farley, Jr. Health Policy Center: Primary Care PMPMs and Behavioral Health Integration Brief (PDF – 236 KB)

5

Align Metrics with Payer Incentives

Identify the specific quality markers your payers care about (e.g., depression remission) and ensure your team is documenting these to trigger value-based payments.

Assistant Secretary for Technology Policy: Health IT Playbook

United States Core Data for Interoperability: Comprehensive Care Use Case

National Committee for Quality Assurance: HEDIS and Performance Measurement

University of Washington: The Value Based Toolkit for Primary Care (PDF – 4 MB)

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NIAC Note: Free Your Mind

Don't get trapped in the mindset that behavioral health must be a profit center in its own right. Instead, look at the total health of your organization. Value isn't just measured in direct revenue; it shows up as recovered provider time, reduced emergency department utilization, and improved management of high-cost chronic conditions. When you shift from siloed to integrated thinking and accounting, the financial justification for integration becomes much clearer.

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Resources

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1. Possemato K, Johnson EM, Beehler GP, Shepardson RL, King P, Vair CL, et al. Patient outcomes associated with primary care behavioral health services: A systematic review. Gen Hosp Psychiatry. 2018;53:1–11.

2. Campo JV, Geist R, Kolko DJ. Integration of Pediatric Behavioral Health Services in Primary Care: Improving Access and Outcomes with Collaborative Care. Am J Psychiatry. 2018 Jul;175(7):432–438.

3. McHugh C, Hu N, Georgiou G, Hodgins M, Leung S, Cadiri M, et al. Integrated care models for youth mental health: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2024 Sep;58(9):747–759.

4. 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. Clin Pract Pediatr Psychol. 2020 Sep;8(3):241–246.

5. 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. Fam Syst Health. 2025.

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

7. 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 Form Res. 2023 Jun 20;7(1):e40274.

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

9. 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.

10. 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;109(12):774–780.

11. Evans TM, Valleley RJ, Haack MK, Thorson R, Joseph J. Physician “Costs” in Providing Behavioral Health in Primary Care. Clin Pediatr (Phila) [Internet]. 2010 Dec 30 [cited 2026 Feb 3]. Available from: https://journals.sagepub.com/doi/abs/10.1177/0009922810390676

12. Thota AB, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012 May;42(5):525–538.

13. Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, et al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA. 2016 Aug 23;316(8):826–834.

14. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012 Aug;169(8):790–804.

15. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012 Oct 17;2012(10):CD006525.

16. Asarnow JR, Rozenman M, Wiblin J, Zeltzer L. Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. JAMA Pediatr. 2015 Oct 1;169(10):929–937.

17. Robinson P, Von Korff M, Bush T, Lin EHB, Ludman EJ. The impact of primary care behavioral health services on patient behaviors: A randomized controlled trial. Fam Syst Health. 2020;38(1):6–15.

18. Duss BG, von Esenwein SA, Glick GE, Deubler E, Lally C, Ward MC, et al. Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study. Am J Psychiatry. 2017 Mar 1;174(3):246–255.

19. Cully JA, Stanley MA, Petersen NJ, Hundt NE, Kauth MR, Naik AD, et al. Delivery of Brief Cognitive Behavioral Therapy for Medically Ill Patients in Primary Care: A Pragmatic Randomized Clinical Trial. J Gen Intern Med. 2017 Sep;32(9):1014–1024.

20. Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, et al. Outcomes of Integrated Behavioral Health With Primary Care. J Am Board Fam Med. 2017;30(2):130–139.

21. Hostutler CA, Shahidullah JD, Mautone JA, Rybak TM, Okoroji C, Bruni T, et al. A systematic review and meta-analysis of pediatric integrated primary care for the prevention and treatment of physical and behavioral health conditions. J Pediatr Psychol. 2024.

22. Jacob V, Chattopadhyay SK, Sipe TA, Thota AB, Byard GJ, Chapman DP, et al. Economics of collaborative care for management of depressive disorders: a community guide systematic review. Am J Prev Med. 2012 May;42(5):539–549.

23. Ross KM, Klein B, Ferro K, McQueeney DA, Gernon R, Miller BF. The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice: A Prospective, Case-Control Program Evaluation. J Clin Psychol Med Settings. 2019 Mar;26(1):59–67.

24. Beil H, Feinberg RK, Patel SV, Romaire MA. Behavioral Health Integration With Primary Care: Implementation Experience and Impacts From the State Innovation Model Round 1 States. Milbank Q. 2019 Jun;97(2):543–582.

25. Nygårdli Z, Littenberg B, Bonnell L, Breshears R, Clifton J, Crocker A, et al. Economic evaluation of implementing a behavioral health integration intervention in primary care settings. Transl Behav Med. 2023 Mar;13(3):571–580.

26. Ritchie MJ, Kirchner JE, Townsend JC, Pitcock JA, Dollar KM, Liu CF. Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration. J Gen Intern Med. 2020;35(4):1001–1010.

27. Yeung K, Richards J, Goemer E, Lozano P, Lapham G, Williams E, et al. Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system. Health Serv Res. 2020;55(6):913–923.

28. Koehler AN, Ip E, Davis SW, Wilburn JF, Lord RW, Marion GS, et al. Cost Analysis of Integrated Behavioral Health in a Large Primary Care Practice. J Clin Psychol Med Settings. 2022 Jun;29(2):446–452.

29. Cicollella DR, Reed S, Shore K, Weissberg J, Pearson S. Integrating Behavioral Health into Primary Care: A Technology Assessment (Final Report) [Internet]. Institute for Clinical and Economic Review; 2015. Available from: https://icer.org/wp-content/uploads/2020/10/BHI_Final_Report_060215.pdf

30. Chavez LJ, Richards JE, Fishman P, Yeung K, Renz A, Quintana LM, et al. Cost of Implementing an Evidence-Based Intervention to Support Safer Use of Antipsychotics in Youth. Adm Policy Ment Health. 2023 Sep;50(5):725–733.

31. 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;32(12):1330–1341.

32. Dopp AR, Smith AB, Dueweke AR, Bridges AJ. Cost-Savings Analysis of Primary Care Behavioral Health in a Pediatric Setting: Implications for Provider Agencies and Training Programs. Clin Pract Pediatr Psychol. 2018 Jun;6(2):129–139.

33. Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, et al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA. 2016 Aug 23;316(8):826–834.

34. Ross KM, Klein B, Ferro K, McQueeney DA, Gernon R, Miller BF. The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice: A Prospective, Case-Control Program Evaluation. J Clin Psychol Med Settings. 2019;26(1):59–67.

35. Unützer J, Katon WJ, Fan MY, Schoenbaum MC, Lin EHB, Della Penna RD, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008 Feb;14(2):95–100.

36. Katon WJ, Unützer J, Fan MY, Williams JW, Schoenbaum M, Lin EHB, et al. Cost-Effectiveness and Net Benefit of Enhanced Treatment of Depression for Older Adults With Diabetes and Depression. Diabetes Care. 2006 Feb;29(2):265–270.

37. Katon WJ, Russo JE, Von Korff M, Lin EHB, Ludman E, Ciechanowski PS. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care. 2008 Jun;31(6):1155–1159.

38. Simon GE, Katon WJ, Lin EHB, Rutter C, Manning WG, Von Korff M, et al. Cost-effectiveness of systematic Depression Treatment Among People With Diabetes Mellitus. Arch Gen Psychiatry. 2007 Jan;64(1):65–72.

Revenue and Savings Considerations

Revenue-Generating and Cost-Saving Benefits

Strategies for Maximizing Integrated Behavioral Health Revenue and Savings

NIAC Note: Free Your Mind

Resources

References