Policy & Financing

Policy & Financing
Sustaining integrated behavioral health care is complicated by policies that often separate the payment of services.

For the field of behavioral health and primary care integration, there are often several health care policy issues that must be addressed to allow for more comprehensive integration across this country. As the field continues to demonstrate the impact of integration through research and demonstration projects, there is growing recognition that policy must change to accommodate a new model of care withstands.

For example, financial policy is often the first item mentioned as needing to be addressed to help sustain integration. Sustaining integrated behavioral health care is complicated by policies that often separate the payment of services into two categories: physical and mental. Having two pots of money to pay for an integrated model poses a challenge for sustaining that model. The separate payment structure often forces clinicians to operate within their professional silos to receive payment1. However, many opportunities and projects2 are occurring right now that could assist in better financing and sustaining integrated behavioral health and primary care.

For example, many health care organizations are discussing how they can better “bundle3” payments around specific illnesses and/or episodes of care. Further, others are moving towards more “global” payment models for primary care2 that could include behavioral health. Data shows how behavioral health interventions in an integrated model can reduce costs4 and readmissions; savings from these reductions could be accrued and reapplied5 to behavioral health to support providers’ services. 

There are many examples of using research to help inform policy, such as with the Miller et al. (2011) paper on the importance of time in treating mental health in primary care6. This study found that patients who present to primary care with a comorbid mental or behavioral health condition spend about 4 minutes longer per visit with their primary care provider. While this may seem insignificant at first, time is a precious commodity in primary care7, and with the prevalence of behavioral health issues presenting to primary care8, these 4 minutes start to add up.

To use another example, consider the role of screening for depression in primary care. The United States Preventive Services Task Force9 (USPSTF) has recommended that primary care practices not screen for depression unless they have the adequate staff-assisted supports in place10 to take care of the positive screens. One study found11 that very few primary care practices (both family medicine and internal medicine) routinely screen for depression despite still reporting the presence of depression in their patients. With integrated practices, the staff-assisted supports are naturally in place due to the presence of an onsite behavioral health provider.

From a health care policy perspective, integration can make a stronger case for itself by showing the value it adds to primary care. Using the two examples above, integration can help save primary care providers time (therefore leading to savings over time) and by assisting primary care in better treating depression subsequent to identification.

Check out the literature repository for more information on integration and healthcare policy.

[1] Kathol RG, Butler M, McAlpine DD, et al. Barriers to physical and mental condition integrated service delivery. Psychosom Med 2010;72(6):511-518.

[2] Colorado Beacon Consortium. Available at: Author. Tear down this wall: Rocky Mountain Health Plans embarks on a mission to bring together behavioral health and primary care.

[3] Closing the Quality Gap Series: The Effects of Bundled Payment Strategies on Health Care Spending and Quality of Care.  Rockville, MD: Agency for Healthcare Research and Quality; June 2011.

[4] M, Palmer S, Hewitt C, et al. Screening for postnatal depression in primary care: Cost effectiveness analysis. BMJ 2009;339:b5203.

[5] Von Korff M, Katon W, Bush T, et al. Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosom Med 1998;60(2):143-149.

[6] Miller BF, Teevan B, Phillips RL, et al. The importance of time in treating mental health in primary care. Fam Syst Health 2011;29(2):144-145.

[7] Agency for Healthcare Research and Quality. The Number of Practicing Primary Care Physicians in the United States: Primary Care Workforce Facts and Stats No. 1.

[8] Roca M, Gili M, Garcia-Garcia M, et al. Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord 2009;119(1-3):52-58.

[9] Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force (USPSTF): An Introduction.

[10] U.S. Preventive Services Task Force. Screening for Depression in Adults, Topic Page.

[11] Phillips RL,Jr, Miller BF, Petterson SM, et al. Better integration of mental health care improves depression screening and treatment in primary care. Am Fam Physician 2011;84(9):980.

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