Have you integrated behavioral health providers into your practice?

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10/25/2018

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

The Medical Group Management Association's most recent MGMA Stat poll asked healthcare leaders if they have integrated behavioral health providers into their practice within the past two years. Nearly one-third (32%) of respondents responded, yes, they have made this change, while a little more than two-thirds (67%) reported they have not. The remaining 1% were unsure. This poll was conducted on Oct. 23, 2018, with 1,313 applicable responses.

Respondents indicating that their practice has integrated behavioral health providers note this is a part of their population health strategy or that they use it for more pointed needs such as smoking cessation or for diabetes or brain tumor patients. Many others said that they have started to use telemedicine as a means of delivering behavioral health care.

For decades, behavioral health has been on the back burner. Inconsistent recognition and substandard payment for behavioral health services have impeded its progression. In addition, primary care physicians shied away from considering the emotional or behavioral component of physical illness, despite data showing they are closely linked.

Behavioral health also has an impact on chronic disease. Between 15% to 30% of people with diabetes also have depression, resulting in worse outcomes, such as higher body mass index (BMI) and increased risk of other conditions (for example, coronary artery disease, cerebrovascular disease and microvascular complications affecting eyes, kidneys, feet and sexual function.) Moreover, up to 33% of those who suffer a heart attack later experience depression. More than one-quarter of adults in the United States experience some type of behavioral health disorder in a given year, according to the Centers for Disease Control and Prevention (CDC). According to a Modern Healthcare article, while 29% of adults with a medical condition also have some type of mental health disorder, close to 70% of behavioral health patients have a medical co-morbidity.

The landmark 21st Century Cures Act, enacted in December 2016, includes a package of reforms and grants related to behavioral/mental health treatments. The law also established an HHS assistant secretary position to coordinate with other agencies and help address federal strategy for mental health and substance abuse treatment. With this act there is hope that care will improve for patients with mental health and substance abuse disorders and payment will be recognized.

In 2010, the Milbank Memorial Fund published Evolving Models of Behavioral Health Integration in Primary Care, which outlines the following barriers that persist to some degree in 2018:

Behavioral and physical health providers have long operated in separate silos. While co-location and employed behavioral health is more common, the integration of physical and behavioral health remains a challenge.
Sharing of information rarely occurs.
Confidentiality laws pertaining to substance abuse (federal and state) and mental health (state) are generally more restrictive than those pertaining to physical health. While HIPAA is often cited as a barrier to sharing information between primary care and mental health practitioners, this is not accurate. Sharing information for the purposes of care coordination is a permitted activity under HIPAA and does not require formal consent. However, many states have restrictive mental health laws that need to be reassessed.
Payment and parity issues are prevalent.

MGMA data show practices are continuing to add behavioral health providers. This is a 5% increase from a similar MGMA Stat poll in November 2016, in which 27% of respondents reported having added behavioral health providers.

References:

Collins C, Levis Hewson D, Munger R and Wade T. "Evolving models of behavioral health integration in primary care." Milbank Memorial Fund. Available from: http://bit.ly/2PoOPms
Johnson S. "Addressing behavioral health to improve all health." Modern Healthcare. Available from: http://bit.ly/2RgwjtD
Szabo L. "Depression in heart attached survivors is common, often untreated." CNN Health. Available from: https://cnn.it/2RcfEHF

Written By

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.