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Session Details

This Collaborative began in February 2015 and ended in January 2016.

To see upcoming programs related to this topic, please visit our Education page.


As the United States moves to value-based care, larger hospitals and health systems are increasingly acquiring and/or aligning with primary care providers (PCPs) to manage patients and serve as the link to all other health care. In addition to high-quality care for physical illnesses, optimal primary care should include screening and treatment of behavioral health disorders, support for patients in engaging in healthy behavior change, such as smoking cessation, and effective self-management support to improve chronic disease outcomes. While many are aware of the importance of this work, organizations have struggled with how to optimize their care teams to integrate behavioral health care due to a variety of factors, such as a lack of sustainable funding models, infrastructural issues, and difficulty operationalizing behavioral health principles into a redesigned care system.
Building integrated and effective primary care teams is key to meeting the challenges that PCPs are expected to address, including:  
  • providing acute, chronic, and preventative care while building meaningful relationships;
  • managing patients with multiple diagnoses, including mental health and behavioral problems;
  • increasing access for newly insured patients;
  • coordinating care; and
  • meeting targets on countless metrics for both cost and quality.
In order to effectively treat the whole person, primary care must build high-functioning practice teams and seamlessly integrate behavioral health capacity into the team. To help organizations do this, the Institute for Healthcare Improvement (IHI), in partnership with the MacColl Center for Health Care Innovation, invites you to join Optimize Primary Care Teams to Meet Patients' Medical AND Behavioral Needs, a 12-month Collaborative designed to create the next generation of high performing primary care teams to address patients' medical and behavioral health conditions and treat the whole person.
This initiative will be based on IHI’s work on behavioral health integration as well as evidence and insights assembled by the MacColl Center through careful study of exemplary primary care practices across the US through a national program of The Robert Wood Johnson Foundation: Primary Care Teams: Learning from Effective Ambulatory Practices (PCT-LEAP). Participants will then deploy these optimized care teams to provide high-quality medical and behavioral health care to their patients.​​​​​​​​​​​​​​​​​​​​

Who Should Participate?

​​This Collaborative is appropriate for organizations committed to improving care in the primary care setting for individuals with both medical and behavioral health needs. Typically these organizations are:
  • Health systems with primary care sites
  • Hospitals with primary care sites (incorporated within or aligned with the hospital)
  • Accountable care organizations (ACOs)
  • Independent Physicians Associations/Organizations (IPAs/IPOs)
  • Large group practices
  • Integrated health systems
  • Community health centers
  • Primary care organizations that might be able to gain support from:
    • Health plans, especially coordinated/managed care organizations
    • Primary care associations
    • States participating in federal demonstration projects
    • Behavioral health services organizations
    • Local community-based organizations
    • Foundations with aligned missions
  • Behavioral health organizations that want to integrate primary care​

About the Content Partners

The Institute for Healthcare Improvement (IHI) ( is a leading innovator in health and health care improvement worldwide. An independent not-for-profit organization, IHI partners with visionaries, leaders, and front-line practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations. Recognized as an innovator, convener, trustworthy partner, and driver of results, IHI is the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health and health care profoundly for the better. Based in Cambridge, Massachusetts, with a staff of more than 140 people around the world, IHI mobilizes teams, organizations, and nations to envision and achieve a better health and health care future. 

The MacColl Center for Health Care Innovation ( at the Group Health Research Institute is the home of Improving Chronic Illness Care. The mission of the MacColl Center is to bridge the worlds of research and clinical care, both within Group Health and nationally. Its goal is to develop, evaluate, and disseminate innovations in health care delivery. Since its inception, MacColl has worked to guide improvement at the practice level by directly working with care teams, leading improvement efforts and providing tools and trainings to providers. At the same time, MacColl has also been active at higher organizational levels, including work with health care organizations, states, and even entire state health systems in other countries. A constant throughout our history has been a commitment to work especially closely with safety net institutions.