Integrating Primary and Behavioral Care

by Christina Thielst via Multibriefs

Mental health and substance abuse treatment have for too long been delivered separately from medical and surgical care. The reality is that medical conditions can contribute to behavioral health, and some mental health conditions co-exist with medical disease.

Consider the patient with a chronic medical condition or post-surgery who becomes depressed or addicted to opioids. Or the alcoholic struggling to navigate the health system developing diabetes, and ultimately requiring an amputation. Or even the aging schizophrenic who sooner or later is impacted by diseases that commonly affect older adults, such as arthritis or cancer.

A few years ago there was great discussion about parity in insurance coverage for medical and behavioral health conditions, and it led to important conversations and legislation. In essence, insurance plans can no longer include annual or lifetime dollar limits on mental health or substance abuse benefits that are less favorable than any such limits imposed on medical/surgical benefits.

Today, there is a new conversation about medical and mental healthcare that is gaining traction — integrated care. Drivers of this whole-person approach to care include the desire to curb the increasing cost of healthcare while improving patient outcomes and meeting consumer demands for efficiency and convenience. Another important driver is the increasing demand for health services from aging baby boomers and the prevalence of preventable and chronic diseases.

Integrated care models systemically coordinate primary and behavioral healthcare for a more effective approach and improved patient satisfaction and outcomes. Evidence-based strategies include embedding behavioral health professionals and case managers on the care team for more seamless hand-offs and using technology and encounter data to identify those patients who seem to need integrated services. The establishment of strong community partnerships is also important.

Integrated care settings can include traditional primary or behavioral health providers, as well as, the medical home models of care. In fact, medical home and integrated care are extremely complementary and share many similarities.

Not every patient will need integrated services, but these new approaches to care delivery for those who do need the extra support can result in:

• reduced fragmentation and costs
• improved access to needed services
• minimized risk of the over utilization of higher levels of care
• a reduction in depression and other undesired outcomes.

Providers who are interested in moving toward more integrated care service must first recognize that traditional professional boundaries and silos of care will be transcended. It will require health professionals look at their care processes through a new lens, exercise some innovative thinking and create strategies for a team approach to coordinating the care needed by patients.

Two sources of information, guidance and other resources available to guide healthcare professionals on a care integration journey:

• The Substance Abuse and Mental Health Services Administration Center for Integrated Health Solutions, which promotes the development of integrated primary and behavioral health services to better address the needs of individuals, whether seen in behavioral health or primary care settings
• The Agency for Health Resources and Quality’s online resources and coordinating center for those committed to delivering comprehensive, whole person care

Christina Thielst, FACHE, is a skilled and innovative hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. Christina is also the author of "Applying Social Media Technologies in Healthcare Environments."