Blog series: This article launches a new series examining mental health care in America and the opportunities to reach more people with effective, timely care. The series will draw on real-world implementation with our partners: Northwestern Medicine, the Meadows Mental Health Policy Institute, and the National Committee for Quality Assurance (NCQA) to explore where the system falls short and how it can be redesigned to deliver better outcomes. We will examine how critical levers, including quality and measurement, policy, workforce, and AI and technology enablement, can be operationalized to expand access to high-quality, measurement-informed mental health care while improving affordability and supporting healthier living for all Americans.
Brain health in America
From depression and anxiety to dementia, brain health across the lifespan shapes how we live and how we age. West Health believes that brain health conditions should be treated like any other chronic medical condition: routinely screened, proactively managed, integrated into whole-person care, measured for impact, and supported by aligned policy and payment. Today, it is starting to happen, but not nearly fast enough.
Thirty-three million Americans are living with depression or anxiety severe enough to need treatment. West Health–Gallup research shows that roughly 7 in 10 Americans want mental health addressed in primary care, but many say these conversations do not happen consistently (West Health–Gallup Survey on Mental Health in America, 2024).
By design and by default, mental health care has been placed out of reach behind a referral, across town, out of network, and often months down a waiting list. Treatments exist, and evidence shows that recovery is achievable. The gap is not a lack of solutions; it is how care is organized.
A core part of that challenge is measurement. The healthcare system lacks a consistent way to define and assess what high-quality mental health care actually looks like. Without that clarity, even proven models struggle to scale.
Together with the National Committee for Quality Assurance (NCQA), Northwestern Medicine, and the Meadows Mental Health Policy Institute, West Health is working to address this challenge: developing a standardized approach to measuring integrated behavioral health quality and creating the foundation for broader system adoption.
Grounded in the Collaborative Care Model
The foundation of our approach is the Collaborative Care Model (CoCM), developed at the University of Washington and validated by more than 90 randomized controlled trials, that embeds behavioral health into primary care teams. It is proven, reimbursable, and scalable; yet still used in a fraction of care settings. The results are well-documented: CoCM reduces depressive symptoms at twice the rate of usual care, improves engagement, and cuts unnecessary emergency department use.
Critically, it pays for itself. Studies show savings from reduced acute care utilization can exceed program costs within the first year, with longer-term savings of $3,000–$6,000 per patient annually, making it one of the few behavioral health interventions with a demonstrated financial case alongside its clinical one.
In 2024, Northwestern Medicine and the Meadows Mental Health Policy Institute, West Health launched the Northwestern Medicine West Health Accelerator to revolutionize the way mental health care is delivered. Our collaboration now spans 80 clinics, more than 500 primary care physicians, and a patient panel of over 500,000 people, and is growing with the aim of providing a blueprint for reshaping care for all Americans.
But implementation alone is not enough. Without shared definitions of success across providers, health systems, payers, and patients, integrated mental health models cannot demonstrate their value, making it difficult to evaluate performance, justify investment, and sustain funding over time.
What we are learning
After a full year of operating the Collaborative Care Model across Northwestern Medicine primary care practices, the clearest lesson is that clinical evidence alone does not drive adoption: operational infrastructure and strong system leadership do. Getting care to more patients across a broad health system requires consistent population-level screening, standardized referral pathways built into the EHR, and sustained primary care engagement.
Billing complexity remains a significant barrier: unclear payer coverage for CoCM codes, consent requirements that create friction at the point of referral, and Medicaid attestation rules that suppress referral volume. Dashboard and registry development took roughly twice as long as anticipated, underscoring the need for health systems to set realistic expectations for the information technology investments required.
Operational challenges emerged early, including payer restrictions, referral patterns, and workforce capacity, all of which influence who gets connected to care. The operational playbook that comes out of this work is as much about solving these implementation challenges as it is about the clinical model itself.
What we are doing
To address these gaps, West Health is working with NCQA to develop a standardized core set of behavioral health quality measures for integrated behavioral health care.
Quality measures are how healthcare turns good practice into standard practice. When measures are embedded into contracts, through reimbursement, incentives, or ratings, health systems invest in the infrastructure needed to deliver on them. This is how fields like diabetes care and cancer screening advanced from innovation to expectation.
Behavioral health has not yet reached that point: not for lack of measures, but for lack of alignment. Too many metrics, too many specifications, no common framework for mental health care delivered in primary care.
Defining the standard: our partnership with NCQA
Our partnership with NCQA is designed to change that.
Together, we are identifying and testing a core set of measures across more than 100 provider groups and 5 million patients in multiple states. By convening strategic partners, including payer coalitions and national partners, this work will ensure broader alignment and adoption.
Northwestern Medicine plays a critical role as an implementation partner by connecting real-world care delivery with national measurement efforts. The goal is not just to measure care, but to define it and establish a shared understanding of what high-quality integrated behavioral health looks like in practice.
Quality
Quality measures are the bridge between innovation and scale. Without them, integrated care remains optional. With them, it becomes expected, measured, and sustained.
Alignment on a core set of measures enables accountability, supports value-based care, and gives health systems the clarity they need to invest in integrated models.
Without measurement, there is no accountability. Without accountability, there is no scale.
Policy, workforce, and technology enablement
While quality is the foundation, scaling integrated mental health care also requires alignment across policy, workforce, and technology.
Policy must remove barriers and support adoption. Workforce strategies must extend the reach of clinicians. Technology must enable data, workflows, and population-level management.
Each of these levers plays a role; but quality is what connects them and translates effort into measurable progress.
Moving from implementation to scale
The path forward is not about proving that integrated care works. It is about building the systems that allow it to scale.
To deliver on this requires alignment: across payers, providers, and policymakers. It requires investment in infrastructure. And it requires a shared framework for measuring success.
This is the role of quality.
The 33 million Americans with unmet mental health needs are not waiting for new discoveries. They are waiting for a system organized to deliver care. Establishing a national approach to measurement is a critical step in building that system.
In the next article in this series, we take a deeper look at quality: examining how standardized measures can drive accountability, align incentives, and transform integrated mental health from a promising model into a national standard.
About the Author
Liane Wardlow, PhD, is Senior Director of Clinical Research at West Health Institute, where she leads national collaborations to develop and scale care models that improve outcomes and reduce costs. Her research spans behavioral health, advance care planning, and palliative care, with a focus on vulnerable populations in primary care settings. She has partnered with national stakeholders to translate research into policy and practice, and her work has appeared in the Journal of the American Geriatrics Society, Psychological Science, and other peer-reviewed journals. She holds a PhD from UC San Diego and a master's degree from the University of Southern California.
