Direct Primary Care-Where Does Integrated Behavioral Health Fit?

Primary care is increasingly viewed as key to growing health system market share in value-based purchasing strategies for both public-and private-sector programs. Yet not all primary care physicians are interested in becoming part of large multispecialty practices or working in employed arrangements. Instead, a growing number of physicians are launching independent direct primary care (DPC) practices in order to maintain professional autonomy, mitigate burnout, and ensure long-term meaningful engagement with patients and families. Given that the typical size of a DPC care team is small, what does this mean for integrating behavioral health? As primary care evolves under various payment and delivery models, the integration of behavioral health services will require adaptability based on practice size, scope of practice, patient acuity, and payment model. Indeed, advocates of integrated behavioral health can "skate to where the puck is going to be"(1) by familiarizing themselves with innovations in primary care, such as the DPC model.