The Primary Care Collaborative is a newly formed group that is working to build a strong, accessible primary care system for all Montanans. The group’s first focus has been on helping Montana Medicaid redesign how it reimburses primary care doctors for the care they provide. While primary care is the anchor of a strong health care system, it doesn’t get the support or financing it needs to provide the level of quality, whole-person care that improves patients’ health and reduces health care costs.

The first call most people make when they are sick is to their primary care clinician. This is especially true in rural communities where primary care providers are called on to handle everything from diabetes to depression, delivery babies, and caring for people in the hospital. National data show that about 35% of all health care visits each year are to primary care, yet primary care receives only about 4% of total health spending.

In Montana, primary care doctors also play an essential role in the state’s behavioral health system. A 2024 analysis of Montana Medicaid claims data found that more than half (54%) of Medicaid members with behavioral health needs received care exclusively from primary care doctors.

To do this well, it takes not only a great doctor but also a strong team.

For the past decade, the Motana Healthcare Foundation has helped primary care practices build teams that can effectively address mental health and substance use needs through integrated care. 

“Integrated care” treats mental well-being and physical health as parts of the same whole. In this model, primary care providers work on teams that include behavioral health provides and care coordinators. These teams screen for behavioral health conditions, provide mental health and substance use treatment, and coordinate care for people who need multiple visits or referrals for more complex conditions.

Integrated, team-based primary care improves health outcomes and patient experience, increases job satisfaction, reduces provider burnout, uses the behavioral health workforce more efficiently, and lowers health care costs.

Through the Integrated Behavioral Health Initiative, we have helped 73 primary care practices implement integrated care since 2016. Today, more than 80% of adult and pediatric Medicaid patients have access to integrated care at an initiative-funded clinic. 

Among the sites currently implementing integrated care:

• Most are screening of 80% of patients for at least one behavioral health condition annually.
• They are exceeding national quality benchmarks for depression rescreening, improvement, and remission.
• All plan to sustain integrated care services after their grant term.

This progress has helped equip Montana’s primary care providers to deliver behavioral health care through effective, team-based models. To sustain and build on this progress – and to ensure that people in rural communities have continuous access to a primary care provider supported by a strong team – primary care must be recognized and funded as the anchor of the health care system.

In 2023, we convened primary care providers, hospital CEOs, state professional associations, and other health care organizations to develop a vision for the future of primary care in Montana. The Primary Care Collaborative was born out of this initial convening and today is a multistakeholder group of 13 organizations whose mission is to strengthen the primary care system in our state by serving as a collective voice.  

Over the last year, the Primary Care Collaborative has worked with Montana Medicaid as it redesigns and begins to implement its new primary care reimbursement system, now known as Primary Care Montana. The system incentivizes “value-based care,” in which doctors are paid based on the quality of care rather than the volume of services they provide. This payment structure would more accurately reimburse primary care doctors for the care they provide and incentivize models such as integrated care, which improve patient outcomes while reducing health care costs.

To build a primary care system that excels for rural Montana, insurers must reimburse practices for all elements of the team-based care model. Montana Medicaid is an important source of reimbursement and has the flexibility to design primary care reimbursement that supports high-quality care.

Some progress has been made, but there is still work to do. Implementing Primary Care Montana represents an important first step. The Primary Care Collaborative will continue working to identify additional needs and solutions to achieve statewide, enduring access to high-quality, integrated, team-based primary care in Montana.

Members of the Primary Care Collaborative: