Patients with Serious Mental Illness (SMI) have high rates of emergency department visits and high premature mortality rates, often due to poor primary care. A model of enhanced primary care services integrated in a behavioral health location is being implemented and studied at the UNC WakeBrook Primary Care Center (UNCWPC). This research was conducted as a retrospective cohort study. ED Visit Utilization before and after establishing care at UNCWPC were calculated for a cohort and a subset of patients. There was a decrease in ED utilization after years 3–4 of enrollment for physical health complaints for the overall cohort (n = 101), from 3.23 to 1.83 visits/person/year, and for patients with multiple physical comorbidities (n = 50), from 4.04 to 2.48 visits/person/year. This study indicated that an enhanced model of primary care can help decrease ED utilization for primary care conditions. The decline was not seen until the patients were well-established.