Integrating Behavioral Health and Primary Care

A growing body of evidence supports the benefits of integrating behavioral health and primary care. Integrated healthcare offers better access to mental health services and reduces inefficiencies in the healthcare system, such as costly emergency room visits.

However, implementing a fully integrated model can be challenging. Several factors must be considered.

Integrating Behavioral Health into Primary Care

A growing number of communities are integrating behavioral health within primary care to convert theoretical access into real access, improve outcomes for depression and other common conditions, and lower overall healthcare costs. The AMA supports this movement to integrate behavioral health into the front offices of physician practices.

Behavioral health integration has been shown to improve patient outcomes and satisfaction, particularly for patients experiencing depression. This approach also reduces the burden on primary care providers, who must address complex medical problems while simultaneously navigating challenging clinical situations and relationships.

Effective integrated models include warm hand-offs that enable PCPs to build trust with behavioral health staff. In addition, practice leaders may want to consider a communication and supervisory structure that ensures collaboration between staff.

There are several models of integrated care that can be implemented by practices, with variations in level of collaboration and the type of behavioral health expertise offered. These models range from a collaborative care model (CoCM), in which behavioral health and primary care share the same patient files, to fully integrated care where both teams function as one unit and work together in the same office space.

The Benefits of Integrated Behavioral Health

Integrated care provides access to more comprehensive, patient-centered and cost-effective care. It can help to eliminate barriers that may prevent patients from receiving treatment, such as the inability to afford or access specialty behavioral health services and challenges with navigating the healthcare system.

Having one place to go for all their medical needs can help individuals feel more satisfied with their care and can also make it easier for providers to identify and treat a range of issues, including behavioral health concerns like depression. This can lead to improved outcomes and a more sustainable healthcare model.

Integrated care models can be as simple as co-location or as complex as full integration and embedment. Providers should consider how to best implement integration based on their current capabilities and goals for the future. They should also review tools to track value like the Integrated Care Practice Assessment Tool and the Agency for Healthcare Research and Quality’s Integration Playbook.

Behavioral Health Integration in Primary Care

A behavioral health specialist can provide patients with support to address a variety of problems including stress, depression, and substance use. Having these services embedded in primary care normalizes discussing behavioral health needs and improves patient outcomes.

Adding BHI to an existing chronic care management (CCM) program gives practices a head start as they already have the standards, operational workflows, and technologies in place. Practices can also create their own BHI programs using ancillary staff or choose to partner with an aligned healthcare organization to deliver the program through its existing technology and care management systems.

Increasing access to integrated behavioral health also addresses barriers that prevent people from getting the help they need, such as lack of insurance, financial constraints, and geographic or racial disparities. Payers have an opportunity to promote this approach through alternative payment models, as well as implementing telemedicine and other enabling technologies to accelerate the pace of adoption and achieving the desired results.

Implementing Behavioral Health Integration

Behavioral health integration models bring mental and substance use disorder screenings, treatment, and coordination into primary care practices. This approach differs from classic care models in which PCPs refer patients with mental health or substance use concerns to behavioral specialists without continuously coordinating their care1.

Effective integrated models require training for PCPs and other clinical staff, redefinition of roles for ancillary providers, and telehealth tools that allow for patient consultation with behavioral health professionals. They have been shown to improve access and treatment outcomes compared to standard care1.

Increasingly, healthcare policymakers recognize that behavioral and physical health are interconnected and that addressing them together is necessary for optimal care. This view is driving the aims and focus of value-based care arrangements through chronic care management (CCM) and behavioral health integration (BHI).