The primary objective is to evaluate the effectiveness of the virtual behavioral health integration (VBHI) program compared to usual care, on reducing the total cost of care reimbursed from Medicare and value-based contracts within 90 days of a patient's primary care visit.

To enhance the care of patients seen in the primary care setting, Atrium Health has designed a virtual behavioral health integration program. A behavioral health care team comprised of licensed clinicians (Behavioral Health Professionals), health coaches, a consulting psychiatric pharmacist and psychiatric providers follow patients for up to 3 months or more depending on patient need after their primary care office visit. This virtual behavioral health integration (VBHI) program is currently available in 36 Atrium Health primary care practices providing support to over 200 providers and medical residents. The Behavioral health Service line is expanding the program to additional primary care practices. Atrium Health and the Carolinas Physician Alliance is interested in evaluating the effectiveness of the program on reducing the total cost of care.

Inclusion Criteria:

• 18 years of age or older
• Primary care office visit
• Have a Patient Health Questionnaire-9 (PHQ-9) and overall score >=10 or Question 9 >0
• Medicare or value-based contract associated with a patient in the past year at the time of the primary care visit.

Exclusion Criteria:

• A patient will contribute to the analysis once using their initial enrollment to either arm of the study.
• No insurance claim for the index primary care visit in the data warehouse upon evaluation.