Merging Behavioral Health and Primary Care: A Commonwealth Fund Podcast

A New Directions in Healthcare podcast by the Commonwealth Fund sought to address “why more practices are merging behavioral health and primary care.” The episode featured NIAC member Jürgen Unützer, MD, Pamela Riley, MD, and Deborah Bachrach.

Unützer is director of Improving Mood -- Promoting Access to Collaborative Treatment (IMPACT) at the University of Washington, a treatment model that integrates primary care and depression treatment. Unützer found that patients who receive Collaborative Care have fewer inpatient stays and visits to outpatient clinics and emergency rooms. Patient satisfaction and patient outcomes also improved. The results of IMPACT studies show that Collaborative Care can help providers to achieve the Triple Aim. Collaborative Care, a specific model of integrated care developed at the University of Washington, treats common mental health conditions that require systematic follow-up due to their persistent nature. Based on principles of effective chronic illness care, Collaborative Care focuses on defined patient populations tracked in a registry, and uses measurement-based practices and treatments to target. Evidence-based medication or psychosocial treatments are provided by trained primary care providers and onsite behavioral health professionals. They are supported by regular psychiatric case consultation and treatment adjustments for patients who are not improving as expected.

According to Riley, the Affordable Care Act creates new opportunities for integrated care as a result of mental health parity regulations and increased numbers of people eligible for insurance through Medicaid expansion. About 25 percent of U.S. adults face behavioral health issues, such as mental health and substance use disorders that can result in poor management of chronic illness and high health care costs. Integrated behavioral health and primary care could reduce spending associated with comorbid disorders.

Bachrach, who previously worked for the New York State Medicaid Office, believes that there are barriers to implementing integrated care, including

  • not having a single point of accountability,
  • disrupted flow of information between providers, and
  • payment and reimbursement challenges.

Many state Medicaid programs reimburse multiple separate providers for physical health, mental health, and substance abuse services. As a result, regulatory, administrative, and purchasing requirements vary and make it difficult to provide integrated care. Some states have instituted Medicaid managed care programs to address this challenge. Bacharach “believes that integration will bring better care and improved access to behavioral health.”

Qualis Health, the University of Washington, and the Commonwealth Fund have produced an online toolkit for community health centers that want to help integrate behavioral health care. Resources include Organized, Evidence-Based Care: Behavioral Health Integration, an implementation guide (PDF - 3578.82 KB). To view other resources, visit the Safety Net Medical Home Initiative.