Leaders at Salt Lake City-based Huntsman Mental Health Institute are refining what they describe as a hybrid behavioral health integration model — blending same-day access in primary care with population-based collaborative care.
Teresa Lopez, director of behavioral health integration, who has helped build the model since its 2015 pilot phase, said integration is not one-size-fits-all. It requires clinical redesign, billing transformation, cultural shifts and sustained data tracking to prove impact and expand access amid workforce constraints.
Primary care doctors initially sought support for treating patients with mental health symptoms beyond prescribing antidepressants, which are not a blanket solution. While the program began as an effort to support providers, it has evolved over the past decade to focus more broadly on expanding access to care.
Huntsman now operates the hybrid model across 11 primary care sites and more than 20 specialty clinics, with 38 full-time equivalents.
The approach combines the primary care behavioral health model — which offers same-day, and sometimes one-time, therapeutic visits during a patient’s physician appointment — with the evidence-based collaborative care model to treat patients with anxiety or depression.
The model emphasizes a team-based approach, with behavioral health clinicians consulting closely with the primary care physicians, clinical pharmacists and care management partners embedded in primary care, she said.
The system can see about six times more patients per individual social worker each year compared to a traditional outpatient mental health clinic.
“A social worker in an outpatient clinic may have a panel of about 100 to 120 patients they see over a course of a year,” Ms. Lopez said. “Our [licensed clinical social workers] are exceeding 800 patients a year that they’re seeing because of this model.”
Many health systems adopt one integration model because billing and reimbursement models differ. Ms. Lopez said using both models provides greater financial flexibility.
“It was really important to us that we were helping to push our system toward more of that value-based care work through the collaborative care model, but also because we wanted to be able to capture the billable work being done through psychotherapy brief visits,” she said.
Leaders are still developing a more unified structure to better understand the model’s profit-and-loss performance.
Under the collaborative care model, services are billed monthly based on time and submitted under the primary care provider. In contrast, the primary care behavioral health model is billed per visit under the behavioral health provider and reimbursed fee-for-service.
To implement the model, the system shifted away from traditional 60-minute therapy sessions commonly used in outpatient settings. Such visits do not align with the pace of primary care. Instead, social workers conduct focused, problem-oriented sessions that address symptoms and establish next steps — similar to a primary care visit.
The collaborative care model also requires maintaining a patient registry and tracking outcomes over time, allowing the system to demonstrate measurable progress to patients, providers and funders.
The system also developed monthly time-utilization reports wherein data is shared with staff to identify areas of opportunity and challenge. The team evaluates the findings and adjusts workflows accordingly, Ms. Lopez said.
