Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States

A Qualitative Study

Published in: Annals of Internal Medicine, Volume 173, Issue 2, pages 92–99 (July 2020). doi: 10.7326/M20-0132

Posted on RAND.org on August 05, 2020

by Angele Malatre-Lansac, Charles C. Engel, Lea Xenakis, Lindsey Carlasare, Kathleen Blake, Carol Vargo, Christopher Botts, Peggy G. Chen, Mark W. Friedberg

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Behavioral health integration is uncommon among U.S. physician practices despite recent policy changes that may encourage its adoption.


To describe factors influencing physician practices' implementation of behavioral health integration.


Semistructured interviews with leaders and clinicians from physician practices that adopted behavioral health integration, supplemented by contextual interviews with experts and vendors in behavioral health integration.


30 physician practices, sampled for diversity on specialty, size, affiliation with parent organizations, geographic location, and behavioral health integration model (collaborative orco-located).


47 physician practice leaders and clinicians, 20 experts, and 5 vendors.


Qualitative analysis (cyclical coding) of interview transcripts.


Four overarching factors affecting physician practices' implementation of behavioral health integration were identified. First, practices' motivations for integrating behavioral health care included expanding access to behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs, and enhancing practice reputation. Second, practices tailored their implementation of behavioral health integration to local resources, financial incentives, and patient populations. Third, barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Fourth, practices described the advantages and disadvantages of both fee-for-service and alternative payment models,and few reported positive financial returns.


The practice sample was not nationally representative and excluded practices that did not implement or sustain behavioral health integration, potentially limiting generalizability.


Practices currently using behavioral health integration face cultural, informational, and financial barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration.

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