Care that stays with the patient, and follows the outcome.
Integral Health delivers the Collaborative Care Model, the most evidence-based approach in behavioral health. Instead of referring patients out and hoping, we build a small team inside the primary care practice they already trust, and we track whether they actually get better.
A referral is not a treatment plan.
More than half of behavioral health referrals never turn into a first visit. The wait is long, the specialist is far, and the patient is already struggling. The need does not disappear. It returns as the chronic disease that will not control, the readmission, and the avoidable cost. Keeping care inside primary care removes the gap where most patients are lost.
Three roles, one shared plan.
The primary care physician
Stays in charge of care, now with behavioral health support built into the practice instead of sent away.
The behavioral care manager
The patient's regular point of contact. Checks in on a schedule, tracks symptoms, and coordinates the plan, in the patient's own language.
The consulting psychiatrist
Reviews the caseload every week and advises on treatment, so patients get psychiatric input without a months-long wait.
From a signal in the chart to a documented visit.
The clinical model is settled. What decides whether it works in a real practice is the sequence around it, and how little of that sequence lands on your staff.
Proactive identification
Screener scores, prescription patterns, discharge events and visit notes are swept together, not one questionnaire at a time.
Flagged where you work
The patient surfaces in the chart or on a worklist for the care team. No separate system to check.
Enrollment
A behavioral care manager reaches the patient within about 48 hours of the flag, and the first appointment lands in days rather than months.
Care delivery
Structured follow-up with the care manager, under weekly psychiatric review of the whole caseload.
Back to the physician
Notes, tasks and social needs land in the record the practice already uses, so the loop actually closes.
We change the plan when the number does not move.
Every enrolled patient is tracked with validated tools like the PHQ-9 and GAD-7. Treatment is adjusted for anyone who is not improving, rather than assuming a single referral solved the problem. A depression score still elevated at week eight is not a data point. It is a signal to act.
In-network first, and a real path when care needs more.
Collaborative Care treats most depression and anxiety inside the primary care practice, where the patient already gets care. When a patient needs more than collaborative care can provide, such as higher-acuity or specialty behavioral health, we do not hand them a phone number and hope. Integral Health arranges coordinated referrals to community and specialty behavioral health, and follows the handoff until the patient is actually seen. Care is delivered in-network wherever it can be, and coordinated out to the right provider when it should be, so no patient is left without a path.
Settled evidence, delivered with operational rigor.
The clinical model is proven. What decides whether the evidence reaches a patient is the operations around it: reaching people who do not self-refer, keeping the registry current, and documenting the work so it gets paid.
Collaborative care for your practice
What primary care practices ask about partnering with Integral Health to run the Collaborative Care Model - staffing, billing, outcomes, and go-live.
Does collaborative care actually work? What does the evidence say?
Yes. Collaborative care is the most rigorously evidence-based model for treating depression and anxiety in primary care, supported by more than 90 randomized controlled trials showing it outperforms usual care on symptom improvement and is cost-effective. It is endorsed by bodies such as the American Psychiatric Association and recognized by CMS, which created dedicated reimbursement for it.
The reason it works is structural rather than anecdotal. Every patient is tracked to a measurable target with validated rating scales, treatment is intensified when a patient stalls, and a consulting psychiatrist reviews the caseload, so improvement is driven by the whole panel reaching response and remission rather than by which patients happen to follow up. Integral Health delivers this proven model and adds AI-enabled coordination so the same evidence base can be scaled to more patients.
Does collaborative care add work for my primary care staff?
No. Integral Health supplies the behavioral care managers and consulting psychiatrists, embeds them into your existing workflow, and runs the behavioral health layer underneath your practice, so your providers keep seeing patients while we own the registry, the documentation, and the billing.
Concretely, your team does not have to:
- Hire, train, or supervise behavioral health staff
- Build or manage the patient registry and measurement-based care workflow
- Track time, code, or bill the monthly CoCM codes
- Learn a separate system, since results surface in the tools they already use
The platform's AI-enabled coordination absorbs the operational lift that normally makes collaborative care hard to staff and sustain, so adding the program does not mean adding tasks or headcount for your team.
Who provides the clinical care, and what are their credentials?
The clinical care is delivered by board-certified psychiatrists and licensed behavioral care managers, working alongside your primary care providers as one team. The consulting psychiatrist reviews the caseload and advises on treatment, while the behavioral care manager handles direct patient contact, follow-up, and care coordination, virtually or in clinic.
Clinicians are licensed in the states where patients are served, and they own every clinical decision. The Integral Health platform supports this team but never substitutes for their judgment, so patients receive specialist-informed care through the primary care relationship they already trust.
How is collaborative care billed, and does Medicare pay for it?
Yes, Medicare pays for collaborative care, and so do Medicaid and a growing list of commercial payers. CoCM is billed monthly based on the time the care team spends managing each patient, using a defined set of CPT codes:
- 99492for the initial month of CoCM
- 99493for each subsequent month
- 99494as an add-on for additional time
- G2214for shorter increments of CoCM time
- 99484for general behavioral health integration where CoCM does not apply
Medicaid and commercial coverage vary by state and plan, and Integral Health manages those payer-specific requirements for you. We handle the time tracking, coding, and revenue-cycle work so documentation meets each code's time thresholds and claims are audit-ready. Because the model is reimbursable, collaborative care is designed to be financially sustainable rather than a net new cost center.
How does collaborative care support value-based care and reduce total cost of care?
Collaborative care lowers total cost of care by identifying and treating behavioral health conditions early, before they drive avoidable medical spend. Untreated depression and anxiety worsen chronic disease and raise utilization, so resolving them upstream reduces downstream costs such as avoidable emergency department visits and inpatient admissions, and improves control of comorbid conditions like diabetes and heart disease.
Because every patient is tracked to measurable improvement, the model directly supports shared-savings, ACO, and risk-based contracts: it improves outcomes, closes behavioral health quality gaps for HEDIS- and Stars-type measures, and produces the population-level reporting payers and ACOs need to prove impact. The program is also reimbursable under dedicated CoCM codes, so it largely funds itself rather than acting as a net new cost center.
What is the difference between the Collaborative Care Model and behavioral health integration (BHI)?
Behavioral health integration (BHI) is the broad category of bringing mental health care into primary care, and the Collaborative Care Model (CoCM) is its most evidence-based, structured form. General BHI can be relatively light-touch, while CoCM adds three defining ingredients that general BHI does not require.
The distinguishing features of CoCM are a designated behavioral care manager, a consulting psychiatrist who reviews the caseload, and a shared registry driving measurement-based care to a target. These map to different billing pathways as well: CoCM is billed under its own monthly codes, while general BHI uses code 99484. Integral Health delivers full CoCM and uses the BHI pathway where it fits a patient's needs.
How does Integral Health compare to hiring our own behavioral health staff?
Integral Health gives you a complete collaborative care program, including the clinical team, the technology, and the billing, without the cost and risk of recruiting and managing behavioral health staff yourself. Hiring in-house means sourcing scarce psychiatrists and care managers, building a registry and measurement-based care workflow, and standing up CoCM billing before you see any return.
We provide all of that as an embedded program, and our AI-enabled platform lets a lean clinical team manage a larger panel than a traditional in-house build of the same size. Your team gets the upside of integrated behavioral health while we carry the staffing, operational, and revenue-cycle burden.
What does implementation and onboarding look like, and how long does it take to go live?
Most practices implement collaborative care and go live in weeks, not months, because Integral Health runs the end-to-end setup and the lift on your side stays minimal. Implementation follows a clear set of phases:
- Scoping plus IT and security review, including the BAA
- Embedding the behavioral care team into your workflow
- Connecting the EHR and registry
- Identifying and enrolling eligible patients
- Go-live, followed by an ongoing outcomes-reporting cadence
Patients are tracked from day one with validated instruments on the registry, so measurement-based care and outcomes reporting are live the moment the program is. The exact timeline depends mainly on EHR integration depth and patient-identification readiness, and you start seeing engagement and symptom data from the first enrolled patients rather than waiting for a long ramp.