Challenges and Solutions
The financial challenges for integrating care are well documented in the literature. For example, Kathol et al. found that "segregated physical and mental health reimbursement practices" were the most significant barrier in achieving practice-level sustainability for integration. Having "two pots" of money to pay for integration often forces mental health providers and primary care providers to operate in the respective arms of their professional silos, therefore making integration more of a challenge.
In response to some of the many financial barriers, federal agencies like SAMHSA have commissioned reports like the 2008 Reimbursement of Mental Health Services in Primary Care Settings (PDF - 1.64MB). This effort included an environmental scan, literature review, and key informant interviews that culminated in a white paper background report. The white paper identifies financial barriers that inhibit practitioners in primary care settings from providing mental health services.
A second aspect of the SAMHSA project involved convening a high-level expert forum with participants representing consumers, practitioners, providers, government, and researchers. Forum members reviewed the white paper and discussed and ranked suggested actions to reduce those reimbursement barriers.
Being able to address the financial challenges associated with integration is a necessary step for the field. Without a true financial solution, practitioners who are interested in integration will continue to face the challenges of paying for care. While the literature has great detail on the financial barriers, the field remains in search of the best financial solution.