Behavioral health integration is a goal often cited by leaders with respect to healthcare transformation. Yet in practice, the term can lack consistent meaning. Eleven leaders shared with Becker’s what real behavioral health integration should look like — clinically, operationally and financially — and where most organizations fall short.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: From an enterprise perspective, what does real integration between behavioral health and the rest of the system look like — operationally, financially and clinically — and where do most organizations still fall short?
Brad Bivens. CFO of Parkside Psychiatric Hospital and Clinics (Tulsa, Okla.): Real integration isn’t about structure or branding, it’s about how the system actually operates. Operationally, it means behavioral health is embedded into core workflows like intake, staffing, throughput and care transitions rather than functioning as a parallel service line. Financially, it shows up in transparent cost and margin visibility, aligned revenue cycle processes and treating behavioral health as a core part of the enterprise rather than an isolated service line. Clinically, it requires shared care plans, governance and accountability across medical and behavioral teams. Most organizations fall short not because of intent, but because incentives, data and ownership remain fragmented, making integration a goal rather than an operating reality.
John Driscoll. President and CEO of Caron Treatment Center (Wernersville, Pa.): The biggest barrier limiting behavioral health effectiveness is that our system is built around episodic, reactive care rather than long-term, integrated treatment for chronic conditions. Addiction treatment has too often operated separately from the broader healthcare system, instead of being fully integrated into ongoing care.
We must integrate behavioral healthcare within traditional healthcare, the way that specialty centers for dermatology, cardiology and orthopedics do. The treatment industry won the parity war 25 years ago. Patients have better access to behavioral care. But we won’t win the reimbursement battle until we integrate our care as other healthcare specialties do.
Our industry must encourage primary care physicians to screen for mental health issues and then refer to treatment centers the same way they’d refer to a dermatologist for a skin issue. And to achieve that integration, we must agree to data-based best practices that do not vary from center to center. Health insurance companies will not cover new and effective therapies until our industry agrees upon standardized, objective metrics that are integrated across the behavioral treatment ecosystem.
Ken Dunham, MD. Executive Director of Medical Operations for Behavioral Health at Sentara Health (Norfolk, Va.): Integration gets us to the point where we say, “I’d never want to practice without behavioral health again.” And our patients deserve this future. There was a time when physicians didn’t routinely collaborate with nurses or pharmacists. Today, such separation would be unthinkable in modern healthcare. That’s exactly where behavioral health needs to be headed. I want to see a future where doctors look back and say, “I can’t imagine how we practiced without therapists.” That’s the level of integration our patients deserve. We need proactive, team-based care with embedded behavioral health that is physician driven and patient focused.
From universal screening and shared care planning to embedded clinicians and consult-liaison psychiatry, behavioral health offers enormous value. In a truly integrated system, a patient admitted for heart failure who screens positive for depression automatically triggers a behavioral health consult request not because a cardiologist remembered, but because the system recognizes that this comorbidity impacts length of stay, readmission risk and outcomes. Now let’s say this patient is a Medicare Advantage member. We know that individuals with CHF and untreated depression cost Medicare up to 75% more. Integrated care identifies those risks early, activates behavioral health and captures the downstream savings. After coordinated care with cardiology and behavioral health interventions, we can save as much as $12,000 per patient per year in total cost of care. Those savings can be directly reinvested through value-based or shared savings arrangements, helping sustain integration programs across the health plan, health system and provider network.
Dave Eldredge. Chief Administrative Officer of Huntsman Mental Health Institute and University of Utah (Salt Lake City): When people talk about “integration,” they often mean it in very different ways. Some mean co-location, others mean warm handoffs and others mean referral speed or shared care plans. From our perspective, true integration only happens when the operational, financial and clinical pieces are aligned — and it’s a challenging feat for most AMCs. Organizations tend to stall when they only solve the clinical piece or the financial piece or the workflow piece. The ones that sustain it ultimately solve all three.
Real integration shows up in how patients actually move through the system. That includes screening, proactive outreach, care coordination, psychiatric consultation, registries, and follow-up after hospitalization or specialty encounters.
One of the lessons we learned is that almost all the value of integration happens between visits, not just in the therapy or psychiatry encounter itself. Without infrastructure around measurement-based care, care transitions and population follow-up, clinics end up with adjacency rather than integration, and patients continue to fall through gaps between primary care, specialty and crisis services.
Integration only becomes sustainable when the cost structure reflects who actually uses what. For us, that meant distinguishing between what we call “access FTE” and “system FTE.”
- Access FTE are the behavioral health clinicians who directly see patients in clinics, manage collaborative care panels and enable throughput for primary care — functions that individual departments consume and therefore should participate in funding.
- System FTE include roles such as case analysts, transitional care, treatment follow-up, providing connection to community resources and administrative infrastructure that support the whole enterprise, generate facility revenue and reduce downstream utilization — functions that no single clinic could reasonably purchase on its own, and therefore require system participation. Our aim this year is to formalize this structure so the departments/divisions can purchase the clinical access they rely on, while the hospital continues to support the system functions tied to quality, transitions and enterprise performance.
Integration means shared accountability for population outcomes. That includes improvement in depression remission, postpartum continuity, chronic disease control and care transitions after emergency department or inpatient discharge.
A key lesson is that the clinicians who serve as the “access FTE” need to function as generalists across diagnostic and acuity ranges, which requires structured and ongoing education to maintain competency across multiple medical and behavioral pathways rather than subspecializing.
We’ve also found that the clinical model matters, primary care behavioral health, collaborative care or a blended model — and the optimal approach depends on the clinical population, available PCP capacity and the level of psychiatric consultation required. The biggest insight for us has been that integration isn’t something you “deploy” — it’s something you operationalize and fund.
Integration also requires senior system-level sponsorship and awareness. The work crosses departments, budgets and clinical domains, which means it can’t be scaled or sustained solely through local champions. We’ve used a cross-functional oversight committee to bring operational, financial, IT, EHR, data/analytics, and clinical leaders into the same conversation so that decisions about staffing, funding, outcomes and clinical pathways are made at the system level rather than in silos.
J.R. Greene. Founder and Chairman of Psychiatric Medical Care (Nashville, Tenn.): Real integration of behavioral health starts with the acknowledgment that our mental health is just as important as our physical health. It requires all healthcare providers to understand that depression, anxiety and other mental health challenges impact much more than just our minds.
We routinely encounter hospitals that are desperately trying to deliver behavioral health services within a system designed primarily for physical care. Even when the need is obvious, the hospital may not have the staffing, workflows or expertise to provide behavioral health services.
One of the biggest gaps is the shortage of behavioral health providers, especially in rural markets. This creates real operational challenges, which often lead to long emergency department boarding times, delayed assessments, limited disposition options,and added strain on hospital teams. Many hospitals may fall short in building continuity of care. They may stabilize a patient, but don’t have a strong pathway into structured, ongoing treatment after discharge.
I believe hospitals should move from a reactive approach to a more integrated and sustainable one, where access to behavioral health providers is consistent, workflows are clear and patients get the right level of care at the right time. That’s only going to happen if hospitals have the right partners, access to providers and systems in place to track outcomes.
Dave Miers, PhD. Senior Director of Behavioral Health at Bryan Health (Lincoln, Neb.): Real behavioral health integration is when a patient can walk into a healthcare facility and receive all of their healthcare needs impacting their mind, body and soul (mental and physical health). It is here where they make one stop, see all the providers they need to see and receive one overall bill. Unfortunately, each state system is set up differently where laws and billing practices prohibit this full extent of integration to take place. However, integration can still take place if providers and systems are collaborative and creative in their thinking and design. Where some systems fall short is in the background and training of their behavioral health core health psychology team.
Laura Shultz, PsyD. Senior Director of Behavioral Health Ambulatory Care at Methodist Le Bonheur Healthcare (Memphis, Tenn.): True integration requires a philosophical shift in which an organization reimagines behavioral health not just as a department but as a strategic function of the mission to provide high-quality, comprehensive healthcare. This reframing is essential. When behavioral health is treated as an adjunct or a separate service, efforts to treat people holistically stall. But, when behavioral health is seen as critical infrastructure for delivering whole-person care, everything changes operationally, financially and clinically.
Operationally, medical and mental health professionals work side-by-side, not simply co-located, but collaboratively treating patients in a care team approach. Hand-offs happen in real-time and flow bi-directionally between the medical and mental health team members. Treatment plans are developed collaboratively and shared amongst medical and behavioral health providers to promote whole-person health. Standardized behavioral health screening tools are integrated into standardized medical workflows, and when positive would then trigger automatic clinical pathways to measurement-based care. Medical providers and behavioral health providers share a medical record to further facilitate communication and collaboration. Behavioral health leaders would be seated at the same table as the medical leaders for decision-making to improve operational workflows and drive quality. Rather than behavioral health being an “add-on” service, it is a vital component of the way healthcare is delivered.
Financially, integration is resourced and valued at the system level. Revenue generated and costs of behavioral health are considered within a medical service line (for example primary care), rather than being expected to function as a separate specialty service. Systems adopt a shared ROI mind-set, justified by system-based values including reduced emergency department utilization, fewer hospitalizations, improved chronic disease control and overall lower total cost of care.
Clinically, integrated care becomes a routine part of overall healthcare, reducing stigma and promoting increased utilization and access. Medical providers will address clinical concerns such as mood, sleep, pain and social stressors that have a negative overall health impact through collaboration with behavioral health experts who can offer evidence-based behavioral solutions in addition to pharmacological approaches to management. The body and mind are viewed as inseparable and treated as one in good medicine.
Where most organizations fall short is in failing to understand that integration is essential to fulfilling their core mission. If a health system’s mission includes health equity, comprehensive and high-quality care, or patient centeredness, then behavioral health integration is no longer optional, it’s fundamental. The systems that succeed are the ones that stop asking how to “add on” behavioral health and start adjusting their lens to acknowledge it’s a structural necessity for any healthcare organization committed to whole-person healthcare.
Jaime Vinck. President of Meadows Behavioral Health (Wickenburg, Ariz.): Integration fails in organizations for the same reason that other initiatives fail: culture. There is a certain cultural preparedness that must occur before change can occur. While it may sound basic, relying on the “culture of safety” that is part of The Joint Commission goals is very effective in creating, or restoring, a culture that can hold their center enough to make changes. For example, in an organization that is culturally safe, employees are openly communicating about the risk of change, without fear of retaliation. In addition, there is confidence that the change will be implemented in such a way that it will not disrupt patient care or experience.
Matthew White, MD. Chair of Behavioral Health Service Line for Sutter Health (Sacramento, Calif.): A successful integration is both vertical within the behavioral health continuum and horizontal across service lines, especially primary care. As a patient’s needs evolve from digital “at home” support to primary care support (collaborative care) to specialty mental health and acute care, a fully integrated program can step patients up and down as their needs evolve and with full visibility for the entire care team. These different care levels and locations are mutually dependent, as some aspects of the continuum financially offset other necessary but less fiscally favorable services — and which may roll up into separate accounting structures. It is our role as integrated leaders to ensure service availability and care transition across the full continuum and to present the financial and administrative package as part of a full patient-centered sustainable ecosystem. This necessitates a broad senior leadership view of behavioral health as a systemwide patient service and full inclusion of clinical and administrative behavioral health leaders in enterprisewide clinical, administrative and financial operations. At other institutions, I have seen less success due to a lack of full inclusion of behavioral health leadership into the financial and operational core teams.
Jill Wiedemann-West. CEO of People Incorporated Mental Health Services (Eagan, Minn.): Integrated care means treating the whole person rather than isolated conditions. It requires diagnostic, interviewing, and care‑planning processes that account for fundamental needs such as food, safety, housing and medication access among others. No clinical intervention succeeds when these basics are unmet. Clinically, integration depends on standards and workflows that consistently identify and address these whole‑person factors to remove barriers and support meaningful progress. Operationally, it calls for breaking down silos and relying on multidisciplinary teams, especially for individuals with complex needs. Financially, it requires a redefining of success, and adopting models that value long‑term outcomes over short‑term gains. It’s a big question — and a heavy lift — but we continue to fall short largely because we avoid the risks that come with simply beginning the conversation.
Wayne Young. CEO of the Harris Center for Mental Health (Houston): Many organizations focus on integrating behavioral health with external healthcare partners but often overlook the need for integration within their own systems. True enterprise‑level integration means aligning mental health services, substance use disorder treatment and whole‑health supports so they function as a unified continuum rather than siloed offerings.
