Evidence-Based Behavioral Health in Value-Based Primary Care: Aligning Incentives to Accelerate Adoption of Collaborative Care.

Behavioral health (BH) is a critical component of value-based primary care. However, access to BH services is a challenge, with a limited, geographically concentrated supply of providers. The Collaborative Care Model (CoCM) is an evidence-based, cost-effective way for value-based primary care leaders to deliver high-quality BH services. Despite a robust clinical and implementation science evidence base, real-world adoption of CoCM remains limited. A key barrier to CoCM adoption is a one-size-fits-all fee-for-service reimbursement methodology, which fails to adequately capture the value of CoCM. Studies show CoCM can deliver a 6:1 return on investment and multiply the impact of psychiatry effort by 7×. The movement of primary care toward value-based payment presents an opportunity to align incentives to increase CoCM adoption and improve access to evidence-based behavioral health. Using the Health Care Payment Learning & Action Network's framework of alternative payment models, we propose policies to facilitate the implementation of CoCM for primary care organizations at different stages of value-based payment-from fee-for-service, to pay-for-performance, to shared savings, to population-based payment. By taking this segmented approach, policymakers can align incentives to accelerate adoption of CoCM and increase access to evidence-based behavioral health at scale.