This article is sponsored by evolvedMD. This article is based on a discussion with Steve Biljan, Chief Commercial Officer for evolvedMD, Dr. Michael Kwame Poku, Chief Clinical Officer at Equality Health, and Dr. Tristan Gorrindo, Chief Medical Officer at Optum Behavioral Care. This discussion took place on October 8th, 2024 at the BHB INVEST conference.

Behavioral Health Business: What problems do you see with the existing behavioral health and physical health systems?

Steve Biljan: That’s a big question. At evolvedMD, we bring behavioral health into physical care settings, which—believe it or not—is still seen as novel. It shouldn’t be, but payment mechanisms and legacy systems make it challenging.

Traditional behavioral health is siloed, which doesn’t align with the concept of whole-person care. You can’t treat behavioral health in isolation and ignore medical care. At evolvedMD, we use the collaborative care model, which has significant research backing from CMS and other sources.

Dr. Michael Kwame Poku: At Equality Health, we’re a Medicaid-focused aggregator and enabler, working primarily with primary care providers across the country to promote high-quality, value-based care. We embrace a whole-person care model, incorporating integrative behavioral health and collaborative care.

The largest challenge we face is the fragmented nature of care models. There’s a false dichotomy between physical health and behavioral health. As a primary care physician, behavioral health wasn’t emphasized in my training. So, a big part of the challenge is educating primary care clinicians and behavioral health professionals to partner effectively.

BHB: Tristan, you’re uniquely positioned as both an executive and a practicing psychiatrist. What are the hurdles you see?

Dr. Tristan Gorrindo: I’ll speak as a practicing psychiatrist. Every time I interact with primary care providers, their number one question is: How do I get more behavioral health support for my patients?

Up to 50% of primary care visits include a behavioral health component, yet we lack the workforce to address it. Access is the critical issue—who can we send patients to? That’s where collaborative care comes in.

This model shifts away from a one-on-one, fee-for-service approach to a population health model. It allows us to deploy behavioral health resources efficiently to address mild to moderate conditions in the primary care setting. This helps free up resources for severe cases in traditional behavioral health systems.

We must think differently. There isn’t a latent workforce of behavioral health providers waiting in the wings to solve this. Collaborative care is our best bet.

BHB: You’ve mentioned collaborative care as a potential solution. Could someone explain the collaborative care model and how it bridges the gaps you’ve highlighted?

Dr. Gorrindo: Collaborative care is a specific evidence-based model with over 100 randomized control trials supporting it. It originated at the University of Washington.

The model places a behavioral health care manager—a “quarterback”—within the primary care clinic. Primary care providers (PCPs) can refer patients directly to this manager, who provides brief interventions, assesses needs, and triages patients. They consult with a psychiatric provider for treatment recommendations, which the PCP implements.

This setup enables a single care manager to handle a caseload of 80–110 patients, compared to the 25–30 patients a traditional therapist might see. It’s a force multiplier, keeping patients in primary care while reducing strain on the broader behavioral health system.

Biljan: To add, the behavioral health care manager supports the PCP, helping manage crises, address behavioral factors influencing chronic conditions, and free up time for other tasks. The psychiatrist acts as a consultant, stepping in for complex cases.

BHB: Let’s step back a bit. How did we get here? What led to the current fragmentation? Michael, your take?

Dr. Poku: A lot of it stems from how payers structured their systems. Physical and behavioral health were treated separately—different systems, different reimbursements. That trickled down to training and care delivery, so we ended up with silos.

Now, we’re trying to reverse decades of separation. But this requires unlearning old habits, addressing workforce shortages, and creating payment models that promote integration.

Dr. Gorrindo: To Michael’s point, structural issues like state laws and privacy regulations—42 CFR, for example—compound the problem. Addressing these barriers is just as critical as fixing workflows and payment systems.

BHB: What about organizational hurdles? What challenges do you face in change management when introducing collaborative care?

Biljan: Change is tough, especially in healthcare, which is already under immense pressure. PCPs might resist because they’re used to seeing depression or anxiety as conditions they can’t treat or get reimbursed for.

But once the model is in place, it’s transformative. Within a few months, we often hear PCPs say, “I can’t remember how we managed without this.”

Dr. Gorrindo: I agree. Some PCPs still hope for an “easy button,” where patients are referred to behavioral health and come back fully treated. But there’s no easy button. They have to learn that managing behavioral health is part of their role, just like managing diabetes or obesity.

Dr. Poku: Data is key. Many PCPs initially say, “Behavioral health isn’t a big issue in my clinic.” But when we analyze claims and show them the numbers, it’s a wake-up call. Data drives accountability and creates an imperative to act.

BHB: Let’s talk about dollars and cents. Are collaborative care models financially viable, especially for behavioral health organizations not already integrated with primary care?

Biljan: Yes, they’re viable. Fee-for-service billing works for this model, and many providers find it profitable. Medicaid is the main challenge. While Medicare and commercial payers support collaborative care, Medicaid adoption is inconsistent across states.

Dr. Gorrindo: For risk-bearing entities, collaborative care unlocks tremendous value. ACOS like Mass General Brigham and U Penn have implemented it systemwide because it improves outcomes and reduces costs.

Dr. Poku: Exactly. Beyond sustainability, collaborative care drives value creation. In risk models, it’s a game-changer for bending the cost curve and reinvesting in innovation.

BHB: What happens if collaborative care isn’t widely adopted?

Biljan: I don’t see it disappearing. Major systems like Kaiser have used it for over a decade because it works. Without collaborative care, the behavioral health crisis would worsen. Traditional approaches haven’t solved it—and they won’t.

Dr. Poku: Without this model, it’ll be nearly impossible to manage costs or address workforce shortages. Collaborative care is essential for improving outcomes at scale.

Dr. Gorrindo: From the clinician’s perspective, collaborative care reduces burnout. PCPs report higher job satisfaction because they have the support they need to manage complex cases. Without it, we risk losing even more providers to burnout.

evolvedMD leads the integration of behavioral health services in modern primary care. Uniquely upfront and ongoing, their distinctive model not only places, but embeds, behavioral health specialists onsite at your practice that allows for immediate collaborative care. To learn more, visit: https://www.evolvedmd.com/.