Integrating physical and behavioral health care and encouraging collaboration and integration across providers is becoming increasingly important, as health care systems attempt to provide higher quality care for lower costs. For many individuals, primary care is the initial health care access point, making screening for mental illness in this setting ever more important; co-occurring mental illnesses often go undiagnosed or untreated because systematic screening for mental illnesses is not a widespread practice in primary care.i As the health care market shifts towards value-based payment systems – many of which incentivize integrated care as a way to address cost and quality benchmarks – all stakeholders will be affected. Given the importance integration and value-based payments have on the treatment individuals with mental illnesses receive, PsychU is taking the month of February to focus on how payers, providers, and consumers are being affected. Check out our special collection of curated resources for this month below.
iCroze, C. (2015). Healthcare integration in the era of the affordable care act. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved January 6 2017 from http://www.integration.samhsa.gov/integrated-care-models/Healthcare_Integration_In_the_Era_of_ACA.pdf
A July 2016 study determined that investment in primary and behavioral health care integration can improve access to primary care for individuals with serious mental illness (SMI).
Approximately half of all care for common mental illnesses happens in the primary care setting.
The Substance Abuse and Mental Health Services Administration (SAMHSA) incentivizes integrated care at organizations through its Primary and Behavioral Health Care Integration Program (PBHCI) in the effort to encourage better health care management of individuals with serious mental illness or co-occurring substance use disorders who are at risk or have primary care conditions or chronic diseases.
Over $128 million has been rewarded to 142 organizations since 2009 under the Substance Abuse and Mental Health Services Administration (SAMHSA) Primary and Behavioral Health care Integration Program (PBHCI) to encourage care integration.
The Collaborative Care Model (CCM) is proving to be one of the most effective integrated care models, so much so that in January 2017 the Centers for Medicare and Medicaid Services (CMS) announced they would begin paying for three key psychiatric CCM services when integrated into primary care settings.
Financing is a major barrier to integrating behavioral and physical health care. According to a February 2016 study, per member per month (PMPM) payments for behavioral health services, and population-based payments (PBP) that include behavioral health are two reimbursement strategies that, once implemented, may increase integration across behavioral and physical health providers.
The Substance Abuse and Mental Health Services Administration (SAMHSA) classifies behavioral and medical health integration on a six point continuum which spans from minimum collaboration to full collaboration in a transformed / merged integrated practice.
The Substance Abuse and Mental Health Service Administration Health Resources and Services Administration (SAMHSA-HRSA) Center for Integrated Health Solutions recommends evidence-based training, among other strategies, to improve integration of the health care workforce.
In a 2012 study, 49.8% of individuals with mood disorders who had depressive symptoms improved at least 50% of their measured Patient Health Questionnaire (PHQ-9) scores when receiving behavioral health consultation in an integrated primary care practice.
Training efforts are needed to prepare clinicians to work in an integrated care setting, with many organizations underestimating the amount of time and training needed to adequately prepare their workforce.