Health care in the United States has been undergoing significant changes since the 2010 passage of the Patient Protection and Affordable Care Act. One of the outcomes of this policy was an attempt to bring physical health care and behavioral health care together in an effort to provide more coordinated care for patients. This change created an opportunity to improve the quality of care for patients, and as a result reduce high cost emergency service that could be prevented through better maintenance of chronic conditions. Three studies were conducted to examine challenges behavioral health agencies face in implementing two models of coordinated care (co-located and fully integrated), staff and organization capacity and needs, and patient service utilization by model of care coordination. The first study used site visits and interviews to capture the challenges faced by agencies. Results from this study indicated that behavioral health agencies faced a number of challenges in providing coordinated care including financial barriers, regulations, information sharing, inadequate technology, and provider training needs. The second study used a staff survey to assess agency and staff capacity and needs in providing coordinated care. The results from this study found differences in capacity based on model of coordination in multiple dimensions related to inter-agency coordination and communication, role clarity, and team cohesion. The third study examined patient service utilization for outpatient visits, inpatient visits, and emergency visits. The results indicated that patients receiving care from co-located agencies were more likely to have at least one encounter in each of the three service utilization categories compared to patients at fully integrated agencies. Overall, the three studies suggest that agencies that have or will implement models of coordinated care face significant barriers that may impact the sustainability or feasibility of such care. Given the findings on patient service utilization, it seems that coordinated care has great potential for patient level outcomes which makes addressing agency barriers even more critical.