Community Health Centers (CHCs) are demonstrating that integrated behavioral health and primary care works. Through multidisciplinary teams and telehealth, CHCs manage some of the nation’s highest-need patients while improving outcomes and reducing avoidable hospital and emergency department use. However, these operational successes also highlight the limits of current payment and policy structures, which have not evolved to fully support integrated care at scale. Sustaining these models requires stable financing and payment systems that support integrated, team-based care.
Teams and Technology are Essential but Not Sufficient
CHCs care for 34 million patients annually, including nearly 3.3 million patients who received behavioral health services in 2024. Behavioral health conditions such as depression, anxiety, and substance use disorders frequently co-occur with chronic diseases, increasing clinical complexity and reinforcing the importance of integrated care.
To better understand how high-performing CHCs are implementing integrated behavioral health care, the National Association of Community Health Centers (NACHC), with support from the Commonwealth Fund, conducted interviews with leaders from 10 CHCs across urban and rural communities. These interviews highlighted how multidisciplinary teams, telehealth, and flexible workflows help CHCs sustain integrated care models despite workforce shortages and financial constraints.
Leaders at Community Care of West Virginia described embedding behavioral health services directly into primary care workflows despite severe rural workforce shortages. At some sites, behavioral health clinicians participate in warm handoffs during primary care visits; at others, primary care clinicians manage common behavioral health conditions with psychiatric consultation and telehealth support.
Multidisciplinary teams are central to these approaches. Primary care clinicians, behavioral health specialists, care managers, and community health workers collaborate to address both clinical and non-clinical drivers of health, including transportation barriers, housing instability, and food insecurity.
Technology has further expanded access to integrated behavioral health services at CHCs. Between 2019 and 2024, telehealth adoption increased from 42% to 98%, and in 2024 approximately one-third of all virtual visits were attributed to behavioral health care. Telehealth has become particularly important for behavioral health services by reducing barriers related to transportation, stigma, workforce shortages, and geographic access.
The NACHC interviews also revealed substantial variation in technology capacity across CHCs. While many organizations reported shared electronic health record workflows and routine telehealth use, fewer had advanced capabilities such as registries, shared care plans, and population-level tracking tools needed to manage patients with complex co-occurring conditions. These gaps create challenges for participation in value-based payment models that depend on outcome tracking, risk adjustment, and coordinated care management.
Value-based Care Shows Promise, but Must Recognize Behavioral Health Complexity
Value-based care (VBC) offers a pathway to better support integrated care by rewarding outcomes rather than isolated services. CHCs participating in accountable care and related payment models have demonstrated improvements in preventive care access, behavioral health integration, and care coordination. However, many current VBC arrangements still fail to adequately adjust for behavioral health complexity, potentially disadvantaging providers serving patients with the highest needs.
Flexible payment policies are essential to effective behavioral health integration. Same-day access to behavioral health services is critical because patients are far more likely to engage in care when behavioral health support is immediately available during a primary care visit. However, many payment systems have historically failed to adequately reimburse same-day medical and behavioral health services, creating financial barriers to integrated care delivery.
Integrated care depends on flexible, team-based workflows in which medical assistants identify behavioral health needs, clinicians initiate treatment, behavioral health specialists provide immediate support, and care managers coordinate follow-up.
VBC also relies on integrated electronic health records to track outcomes across primary care and behavioral health providers. CHCs use these systems to coordinate care and share performance data with payers and state agencies, supporting accurate risk adjustment and benchmarking. Sustained funding is essential to maintain these capabilities, ensuring CHCs can demonstrate outcomes, successfully participate in VBC, and contribute to system-wide improvement.
Integrated Care Requires Stable Financing
Integrated behavioral health care depends on stable financing to support multidisciplinary teams, telehealth infrastructure, care coordination, and ongoing patient management. Medicaid plays a central role in sustaining these services, accounting for 44 percent of total CHC revenue in 2024.
Recent Medicaid eligibility redeterminations and proposed policy changes threaten coverage continuity for millions of CHC patients, potentially increasing uncompensated care and placing additional financial strain on health centers. Without stable coverage and adequate reimbursement, CHCs may be forced to scale back behavioral health integration and other essential services despite strong evidence of effectiveness.
Structural Reform is Essential
CHCs show that integrated behavioral and chronic care can work, but only when aligned policy, payment, and workforce strategies are in place. Policymakers and payers must act on three fronts:
- Investments in workforce capacity and telehealth infrastructure must be sustained long term. CHCs cannot maintain integrated behavioral health care models through short-term grant funding alone. Stable Medicaid coverage and adequate reimbursement are essential to sustaining staffing, technology, and patient access.
- Payment models must support integrated, team-based care. Reimbursement should recognize same-day medical and behavioral health services, care coordination, and the non-visit work required to manage patients with complex behavioral and chronic health needs effectively.
- Value-based care models must adequately adjust for behavioral health complexity. Risk adjustment and performance measurement should reflect the additional coordination, time, and clinical intensity required to care for patients with co-occurring conditions.
CHCs have demonstrated that integrated behavioral health and primary care can improve access, coordination, and outcomes for patients with complex needs. The next step is ensuring that payment, workforce, and Medicaid policies evolve to sustain and scale these models nationwide.
