Behavioral Health Integration: An ICER Evidence Review Topic

Behavioral health integration (BHI) served as the topic for the most recent evidence review conducted by The Institute for Clinical and Economic Review (ICER). ICER is a non-profit, health care research organization based in Boston that focuses on assessing the comparative clinical effectiveness and value of different health care interventions. According to the ICER Report (PDF - 139 KB):

“Up to 70% of physician visits are for issues with a behavioral health (i.e., mental health or substance use) component, and an equal proportion of adults with behavioral health conditions have a comorbid physical health issue. Patients with chronic illnesses such as diabetes, obesity, cancer, or asthma are more likely to experience mental illness (Katon, 2011). Moreover, care for patients with comorbid behavioral health conditions can cost 2-3 times more than for patients without these comorbidities (Milliman, 2012), and these individuals have shorter life expectancies than the average person (Druss, 2011). Additional health care costs related to behavioral health comorbidities were estimated to be $293 billion in 2012, with approximately 217 million days of work lost annually to behavioral health conditions, costing $17 billion/year (Milliman, 2012).”

Drafts were produced and reviews were conducted by two components of ICER—The New England Comparative Effectiveness Public Advisory Council  (CEPAC) in Boston, and The California Technology Assessment Forum (CTAF) in San Francisco. Leading national experts on BHI served as key informants to this work and participated in the meetings to help develop a set of policy recommendations that are featured in the evidence review, as well as a separate policy brief.

Evidence Review (Final Report): This assessment evaluates the evidence on the clinical effectiveness and value of the integration of behavioral health services into primary care settings and reviews barriers and potential policy options for the implementation of such integrated care in the United States generally and in selected states. 

Policy Brief: This 6-page policy brief distills the major recommendations born out of ICER’s evidence review to help guide the application of evidence to the implementation of behavioral health integration. The recommendations are based on interviews conducted with national and regional experts in New England and California, as well as the policy discussions that took place at each meeting for CEPAC and CTAF. 

New England and California Action Guides: Two action guides were developed pairing key recommendations from the report with resources to provide further background and implementation support to help stakeholders translate and apply the guidance to practice and policy (all resources are hyperlinked). General/national information is provided, along with resources specific to each state.  

Note: Among those participating were experts affiliated with the AHRQ Academy and National Integration Academy Council (NIAC).

Respondents to Call for Public Comments on Draft Report Included: Macaran A. Baird, Alexander Blount, Roger Kathol, Neil Korsen, C.J. Peek, and Jürgen Unützer.

Academy/NIAC Authors cited in the Report: National Integration Academy Council (NIAC), Alexander Blount, Stephen Melek, Benjamin Miller, C.J. Peek, and Jürgen Unützer.

Policy Roundtable Participants (CEPAC): NIAC Members Parinda Khatri and Neil Korsen.

Key Informant Interviews: Were conducted with The University of Colorado – Denver, represented by Benjamin Miller; The University of Massachusetts Medical School, Center for Integrated Primary Care, represented by Alexander Blount; The University of Minnesota Medical School, Department of Family Medicine and Community Health, represented by C.J. Peek; and The AHRQ Academy/NIAC represented by Drs. Miller, Blount, and Peek.

Clinical Expert Calls Participant with CTAF Panel and CEPAC Council: C.J. Peek.

Resource Citations Cited: AHRQ Academy, NIAC, Portal, Lexicon, Atlas, and Professional Practices Guidebook (Workforce) resources were cited in the Report, and listed as National Resources in Action Guides.

Posted July 2015