Integrated care is an opportunity and an imperative

[This article is part of the 2026 Trends Report]

Although health care faces a range of uncertainties, psychologists’ role as members of integrated health care teams is a movement that is poised to grow, say experts in this area of practice.

“In my opinion, integrated primary care is key to the long-term success of psychology,” said Jeffrey T. Reiter, PhD, a leading integrated care expert and consultant who has helped establish integrated care practices in the United States and internationally. Nearly 20% of the mental health workforce works in primary care, yet 80% of primary-care providers don’t have a mental health professional on their team, he noted (see The State of Integrated Primary Care and Behavioral Health in the United States 2022, Robert Graham Center, May 31, 2022). “That’s a tremendous amount of growth potential.”

In a related vein, while approximately 1 in 3opens in new window Americans has a mental health or substance use disorder, only about 1 in 12opens in new window will see a therapist, he added. Hence, “primary care presents a major opportunity to improve mental health for millions of Americans.” (Olfson, M., et al., Annals of Internal Medicine, Vol. 177, No. 3, 2024opens in new window; National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, 2024opens in new window.)

Specialty integrated care—mental and behavioral health services embedded in specialty medical areas like oncology and cardiology—is likewise an important growth area for psychologists, said Amy Walters, PhD, director of behavioral health services for St. Luke’s Humphreys Diabetes Center in Boise, Idaho. She is also a member of the APA Integrated Specialty Care Advisory Group, whose mission is to provide direction and resources to enhance and sustain psychologists working in integrated specialty care settings.

Patients receiving specialty integrated care services tend to have chronic or serious conditions, and as a result, cost the system a disproportionate amount of money. But they are also a population that benefits tremendously from behavioral and psychological interventions that encourage lifestyle changes, reduce depression and anxiety, help with medication adherence, and improve the ability to cope with chronic conditions, Walters said.

“As health systems become more accountable for providing care at the population level, they can save significant costs by keeping specialty care patients out of emergency rooms and hospitals,” she said. “Behavioral health plays a critical role in that.”

And people want this care, research shows. In a 2024 surveyopens in new window by Gallup and West Health, a group of nonprofit and nonpartisan organizations focused on health care and aging, 70% of Americans said they would prefer to be asked about both their physical and mental health during medical appointments with their primary-care providers. Meanwhile, 51% of those surveyed said it was “very important” that primary-care providers screen patients for anxiety and depression.

Perhaps more than any other mental health professional, psychologists have unique and valuable skills to offer these systems, including expertise in assessment, diagnosis, research, and communications skills, Reiter added.

“The breadth of our training and experience leads a lot of clinics to put psychologists in leadership positions,” including as department heads, administrators, and even heads of health care organizations. “So there are opportunities not only to serve people as clinicians but to really play a role in developing and leading in integrated care.”

Data show distinct benefits to integrated care arrangements, with systems that use them demonstrating higher quality of care, improved outcomes, and reduced costs compared with usual care. For instance, a meta-analysis of 69 integrated primary-care interventions showed they improved patient access, continuity of care, and cost compared with standard primary-care interventions (Zhang, Y., et al., Health Research Policy and Systems, Vol. 23, No. 1, 2025opens in new window). Another study of 113 primary-care practices found that patients who received integrated care experienced higher quality of care, had lower rates of acute care use, and cost the system less than those in usual care (Reiss-Brennan, B., et al., JAMA, Vol. 316, No. 8, 2016opens in new window).

Overall, having more psychologists involved in integrated care aligns perfectly with APA’s mission to provide mental health services to all those who need it, said APA CEO Arthur C. Evans Jr., PhD.

“Integrated care isn’t simply about expanding where psychologists practice,” he said. “It’s about reimagining how we address mental health at a population level. When we embed psychological services into medical care, including primary-care and community health settings,” he said, “we can reach individuals earlier, reduce stigma, and dramatically expand access for those who have historically been left out of traditional mental health systems. For the profession, this represents both an opportunity and an imperative.”

As psychologists become more involved in integrated care, APA and others are addressing billing and reimbursement issues, a traditional sticking point for psychologists’ involvement. A team headed by Erin F. Swedish, PhD, director of health integration at APA and chair of both the Specialty Integrated Care Advisory Group and the related Integrated Primary Care Advisory Group, has been working to expand psychologists’ access to and use of existing procedure codes in integrated care settings. Meanwhile, a bill championed by APA that is pending in Congress, the Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Actopens in new window, or COMPLETE Care Act (S. 931/H.R. 2509), would temporarily increase Medicare reimbursement rates for primary-care practices and provide technical assistance to help them adopt integrated care models (see October 2025 Monitor).

“Integrated care is reshaping the future of health care,” said Swedish. “When psychologists are part of the core medical team, we can address behavioral and physical health together. That’s how we transform outcomes, reduce costs, and deliver care that truly meets people where they are.”

Psychologist Parinda Khatri, PhD, is a key example of the value that psychologists can bring to health care settings. She is CEO at River Valley Health (formerly Cherokee Health Systems), a designated federally qualified health center and licensed community mental health center in Tennessee and one of the oldest integrated care systems in the country. Over time, and thanks in part to her leadership, the system has demonstrated that its integrated, team-based, whole-person, data-driven approach has dramatic results for patients overall, landing the system in the top tier of federally qualified health centers for clinical performance each year for the past decade, according to the Uniform Data Systemopens in new window, a standardized data reporting system developed by the Health Resources and Services Administration.

Khatri, who continues to provide patient care to primary-care and substance use patients, described work with one patient who entered the system with extensive medical problems including chronic obstructive pulmonary disease, kidney disease, renal disease, and hypertension. He also had a history of substance use disorder with alcohol and crack cocaine and was highly depressed as well.

To tackle these complex issues, Khatri and the patient’s primary-care physician worked together to better manage his hypertension and kidney function, meaning they also needed to address his substance use problems if meaningful change were to occur. Khatri began the behavioral health aspect slowly, building a relationship with him during his regular primary-care visits for hypertension and introducing ideas from cognitive behavioral therapy, acceptance and commitment therapy, and motivational interviewing. Over time the patient saw the power of these approaches, which included building a sense of self-efficacy and coping with addiction triggers. The strategies worked so well for him that he now uses them to monitor his medical issues as well.

“One reason our system is able to help people achieve good clinical outcomes on traditional physical health conditions is that we use an integrated model of care that incorporates behavioral and psychological interventions to improve management of these conditions,” Khatri said.

Similarly, as former section chief for psychology at Louisiana State University Health Sciences Center, Michelle B. Moore, PsyD, now an assistant dean for faculty there, witnessed many positive clinical outcomes while overseeing a team of psychologists who work directly with medical providers to treat patients in the system’s cancer center, OB-GYN clinic, HIV outpatient clinic, bariatric clinic, and hospital.

Having psychologists available for “warm handoffs” benefits patients and providers alike, destigmatizing mental health care for patients and relieving providers of having to address emotional and psychological issues on top of medical ones, she said.

“This coordination of care is just more comprehensive for the patients,” Moore said. “We’re treating the whole person better when psychological care is actually integrated into the system.” (See sidebar for more examples).

Theoretically, it’s hard to argue with the value that integrated care can provide. But on the ground, it has faced some hurdles. Until recently, many health care systems and administrators didn’t fully grasp the range of skills and expertise that psychologists can offer and didn’t have proper mechanisms to reimburse them.

But progress is happening. Besides APA’s work on reimbursement issues, providers and health systems are seeing the importance of psychologists’ involvement in both primary-care and specialty care settings, said Walters. “In the beginning, I think they struggled to understand the role that psychologists could play and how we were different from social workers, other than being more expensive,” she said. “So that has been a work in progress. But we have definitely received a lot of positive feedback from our administrative team over time as they’ve seen the programs we’ve been able to develop.”

In terms of education, APA’s 2025 revised Guidelines for Psychological Practice in Health Care Delivery Systemsopens in new window provides updated guidance for psychologists interested in or already working in integrated and collaborative care settings, emphasizing the importance of interprofessional collaboration, care coordination, and the role of psychologists in population health initiatives. The guidelines also highlight best practices for team-based care, measurement-based approaches, and consultation/liaison roles, one of the integrated care roles that psychologists can take on.

Meanwhile, Reiter and others are making the case with psychology training organizations such as the Council of University Directors of Clinical Psychology that integrated care should be a standard part of graduate school curricula. “If integrated care is going to be sustainable for the field, we have to get people ready to go on day one,” Reiter said.

As a leader and provider who has seen the benefits of integrated care for patients over many years, Khatri believes this mode of service delivery will outlast any difficulties of the present era.

“Our country is navigating a number of external forces that are stressing and disrupting the health care system,” she said. But in her practice, “we’re very committed to doing what is needed to fulfill our mission, which is to provide access to comprehensive and integrated care to everyone, regardless of ability to pay. That is, and will remain, our North Star.”