Making Collaborative Care Work: Overcoming Barriers to Integrating Mental Health in Primary Care

Integrating mental health services into primary care is no longer a theoretical ideal—it’s a practical necessity. In this conversation from the ACP Internal Medicine Meeting 2025, Matthew Press, MD, shares real-world strategies for implementing the collaborative care model, including how to navigate payment systems, manage health IT limitations, and build a sustainable workflow. He also offers his vision for the future: a health care system where mild to moderate mental illness is routinely treated in primary care settings, freeing up access to specialty services and improving outcomes across the board.

Dr Press, is an associate professor of medicine in the division of general internal medicine in the department of medicine at Perelman School of Medicine at the University of Pennsylvania, in Wynnewood, PA.

The following transcript has been edited for clarity, style, and length.

Patient Care: What are some of the common barriers primary care physicians face when attempting to integrate mental health services, and how can they be overcome?

Matthew Press, MD: The first thing we have to talk about is payment. The collaborative care model has been around for many years, but it wasn’t until 2015 that Medicare introduced specific payment codes for it. That step really enabled clinicians to start getting reimbursed for delivering collaborative care. Now, nearly a decade later, most payers do cover these CPT codes—but I still encourage practices to check with their local payers to confirm. They absolutely should be covering them. If they’re not, please let us know—whether through the American College of Physicians or other specialty societies—so we can advocate for that.

There is a bit of work involved in setting up the ability to bill for these services. These are time-based codes, which means you track the time the care manager spends working with patients over the course of a month, then map that to the appropriate code. One of the strengths of this model is that it’s flexible: the care manager’s interactions don’t have to occur in person or in any specific setting. If a patient no-shows for a visit, the care manager can pivot and work with others from the registry. But you do need someone in your billing office to reliably translate those time logs into billable codes.

Bottom line: nobody should be doing this work without getting paid for it. These codes were designed to cover the cost of delivering collaborative care—and in most cases, you should at least be able to break even on the resources it takes.

The second major barrier is health IT infrastructure, especially the electronic medical record (EMR). You can start with basic tools—a registry is just a list of patients actively enrolled in collaborative care so the care manager can follow up proactively. But ideally, your EMR can also support symptom measurement and tracking over time. It’s helpful if patients can complete these assessments through a portal, too. These are things that can be added incrementally, though. My advice is: keep it simple at first. Don’t let the perfect be the enemy of the good. You can enhance your tech systems over time once the program is up and running.

Patient Care: What are your hopes for the future of integrated behavioral health services in primary care?

Matthew Press, MD: I don’t see any reason why every primary care practice in the country shouldn’t have integrated mental health services. That’s the only way we’re going to make real progress in addressing the mental health crisis.

Roughly 50% of people with mental health conditions have mild to moderate symptoms—depression, anxiety, some substance use. If we can care for those patients within the primary care setting, we can dramatically reduce the burden on the specialty mental health system. That would free up access for individuals with more severe mental illness, who really need that level of specialized care.

Ultimately, I think this approach can lead to better individual outcomes—lower rates of depression and anxiety—and improved outcomes at a population level, too. It can also relieve pressure on primary care clinicians, giving them more tools and support. This kind of care should be as routine as managing diabetes or hypertension.

For more of our conversation with Dr Press at ACP 2025 check out:

• Bringing Mental Health into Primary Care: A Conversation with Matthew Press, MD
• Collaborative Care for Mental Health: A Scalable, Team-Based Model for Primary Care
• Matthew Press, MD: How Penn Medicine’s CoCM Model Helps PCPs Treat Mental Health—and Avoid Burnout
• Bringing Behavioral Health Into Primary Care: A Collaborative Care Roadmap

For more 2025 ACP Internal Medicine Meeting coverage, please click here.