“Perfect Storm” Encourages Integration of Behavioral Health and Primary Care



The Commonwealth Fund recently reported on new payment models as an impetus for integrating behavioral health and primary care. Coupled with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act which builds on MHPAEA and requires coverage of mental health and substance use disorder services as one of 10 essential health benefits categories, significant barriers to integration are being removed. Patient convenience and their preference to avoid the stigma still attached to separate psychiatric care also play into the growing call for integration. Michael Hogan, PhD, points out that “All of this is creating a perfect storm to encourage integration.” 

Behavioral health conditions are very common, affecting nearly 1 of 5 Americans and leading to health care costs of $57 billion a year. Conditions such as depression can be very disruptive, occurring in all ages, co-occurring with chronic medical conditions, and leading to significant disability.  In spite of this, behavioral health care is mostly separated from the primary care system. The report further notes that the Institute of Medicine concluded 20 years ago that two largely independent systems of care for medical and behavioral health care produce poorer health outcomes and higher costs. While there has been mounting evidence of this, there have been significant barriers to integrating care, some of which remain, despite encouraging signs of progress. Integrated care is still rare, and there has been “little or no financial incentive or administrative advantage to bringing the two systems together.” Roger Kathol, MD, CPE, notes that “Payment is the heart of the problem.” The report profiles health care organizations that have made strides in integration and the fact that most of these have been accomplished, in part, through grants, Medicare and Medicaid demonstration programs, and the willingness of some health systems to absorb the initial costs of making this change.

Despite the progress, significant barriers to integrated care remain. Among those noted are:

“Health care as a system has not evolved to align financial mechanisms, practice delivery, training, and education, and even our community expectation, to support a model of care that integrates behavioral health.”—Benjamin Miller, PsyD, director of the Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine, and Academy Principal Investigator

“If we are going to look to develop a high-performing health care system that deals with the totality of medical costs—ignoring mental health and substance use as drivers of costs and human suffering will not work. These illnesses are too big to ignore and too important.”—Paul Summergrad, MD, American Psychiatric Association President

Please read the report in its entirety In Focus: Integrating Behavioral Health and Primary Care. Additional resources may be found in the Academy Literature Collection and by searching the Academy Portal for news and information on the topics of payment, policy, and parity.