The Case for Aligning Behavioral and Primary Care in Managed Care

The Centers for Medicare & Medicaid Services (CMS) is supporting behavioral health integration through the ACO Primary Care (PC) Flex Model.² This model is designed to improve access to high-quality, team-based primary care for underserved populations, including integrated behavioral health services.

The model introduces a Prospective Primary Care Payment (PPCP) methodology, offering accountable care organizations (ACOs) a flexible, predictable funding stream for delivering comprehensive care. Unlike traditional fee-for-service models, PPCP supports whole-person care and offers increased payments for providers serving high-risk, low-income, or rural communities.

To advance health equity, PPCP rates may be based on average county-level primary care spending rather than historical utilization, enabling more equitable reimbursement for ACOs with historically lower payments. CMS also provides additional support for providers serving vulnerable populations.

PPCP provides ACOs with financial flexibility to reimagine care delivery. By decoupling reimbursement from in-person visits and aligning payments with the needs of a defined population, PPCP encourages practices to engage patients through multiple modalities, including virtual visits, team-based assessments, and community outreach.

This flexibility is particularly valuable for behavioral health integration, where care often requires non-traditional approaches. PPCP also supports services that are commonly unreimbursed in fee-for-service environments, such as behavioral health screenings, care coordination, and navigation of social needs—critical components in managing behavioral health conditions before they escalate.

Participating ACOs can reinvest predictable revenue from PPCP into workforce expansion, training, and health IT infrastructure to improve population health outcomes.

Behavioral health integration addresses longstanding inequities in access and quality of care. According to the National Institute of Mental Health, adults in rural areas experience mental illness at rates comparable to those in urban areas but are significantly less likely to receive treatment.³ When treatment is available, it is often delivered by providers lacking specialized behavioral health training.

The PC Flex Model’s equity-focused design—which includes enhanced reimbursement for high-need regions and flexibility in care delivery—offers managed care organizations a mechanism to address these gaps.

It also enables coordinated care for patients with complex medical, behavioral, and social needs. Many individuals with serious mental illness or substance use disorders face concurrent challenges such as housing instability, food insecurity, or lack of transportation. With flexible funding, ACOs can partner with behavioral health providers and community-based organizations to develop care models that reflect the full context of patients’ lives.

Commercial managed care organizations are increasingly investing in behavioral health integration. Evidence shows that combining behavioral and physical health improves chronic disease management, reduces unnecessary utilization, and enhances patient outcomes.

For example, Humana⁴ has reported that many of its value-based care partners embed behavioral health specialists within primary care clinics to enable timely referrals and stronger care coordination. Similarly, Cigna’s Evernorth⁵ has introduced a value-based behavioral health program focused on treatment outcomes. By emphasizing evidence-based metrics and reducing administrative burdens, the program supports collaboration between payers and providers.

With the implementation of the PC Flex Model, commercial and public payers must work closely with provider networks to capitalize on the opportunity for integration. This includes reassessing data-sharing agreements, care coordination workflows, and network development strategies. Payers that incentivize integrated care models and support providers in the transition to prospective payment will be best positioned for success in value-based arrangements.

Quality metrics are also evolving to reflect integrated care delivery. Measures related to behavioral health screening, timely follow-up, and reduced behavioral health–related hospitalizations are increasingly incorporated into value-based contracts. Health plans should evaluate their ability to capture, monitor, and respond to these measures—and identify where technological or operational gaps exist.

For managed care organizations, integrating behavioral health is not merely an add-on—it represents a strategic inflection point. Advancing integration requires aligned incentives, scalable infrastructure, and a long-term commitment to health equity and whole-person care.

1. Hawrilenko M, Smolka C, Ward E, et al. Return on investment of enhanced behavioral health services. JAMA Netw Open. 2025;8(2):e2457834. Published 2025 Feb 3. doi:10.1001/jamanetworkopen.2024.57834
2. ACO Primary Care Flex Model. CMS.gov. Published January 1, 2025. Accessed August 21, 2025. https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model
3. Morales DA, Barksdale CL, Beckel-Mitchener AC. A call to action to address rural mental health disparities. J Clin Transl Sci. 2020;4(5):463-467. Published 2020 May 4. doi:10.1017/cts.2020.42
4. Humana. Humana’s 11th value-based care report. Published February 5, 2025. Accessed August 21, 2025. https://policy.humana.com/issue-area/news-and-resources/news-press/2025/value-based-care-simplifies-healthcare-for-patients-and
5. Minemyer P. Evernorth rolls out measurement-based care program for behavioral health. Fierce Healthcare. Published October 6, 2023. Accessed August 21, 2025. https://www.fiercehealthcare.com/payers/evernorth-rolls-out-measurement-based-care-program-behavioral-health

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