Practice Notes

How can you integrate behavioral health with primary care?

by William Hudec

The statistics on the prevalence of behavioral health are staggering: In the U.S., nearly a quarter of adults have a diagnosable behavioral condition, and two-thirds of Medicaid patients with COPD, CHF, coronary artery disease, diabetes, or hypertension also have at least one behavioral health comorbidity.

Yet more than half of U.S. counties have no practicing psychiatrists, clinical psychologists, or social workers.

Related study: Proactive Behavioral Health Management

The outstanding question from medical group executives isn’t if behavioral health should be integrated at the primary care setting, but how it should be done. Medical groups have some tools at their disposal to address the behavioral health care shortage, but they aren’t without their own challenges. 70% of primary care visits result from psychosocial issues, but most primary care providers and care teams are poorly equipped to address these underlying causes.

Co-located behavioral health services lead to the ‘warmest of warm handoffs’

Montefiore Medical Group is a 350-physician employed medical group serving a relatively poor, underserved patient population in The Bronx. Their location and patient mix led them to embrace population health and care management far ahead of their peers.

In one classic example from the early 2000’s, Montefiore ran a pilot where it placed behavioral health services in a few of its care sites. At first, the organization explicitly limited services to toddlers and infants. However, Montefiore recognized that mothers also began taking advantage of these services for their own postpartum depression and other conditions, providing yet another clue that there was a broad, unmet need for behavioral health in their community.

Behavioral Health Strategic Plan Template

Soon, Montefiore’s pediatricians were regularly referring the parents of their patients for behavioral health services. The convenience of co-located behavioral health care ensured that a pediatrician could see her patient, and simultaneously call over a behavioral health specialist for the parent while the child was being seen. In the words of Montefiore Medical Group’s Chief Medical Officer Dr. Andrew Racine, "It is the warmest of warm handoffs you can possibly get."

Now with a decade of experience under its belt, the organization is introducing adult behavioral health to all of its practice sites. The roll-out has two primary goals:

  • Use universal screenings at the beginning of each visit to detect underlying conditions like anxiety and depression, thereby improving patient outcomes
  • Improve medicine and treatment adherence among chronic patients by addressing behavioral conditions that contribute to chronic disease symptoms

Overcoming key challenges

Dr. Racine understands that Montefiore will need to navigate several operational challenges.

Insufficient capacity
Montefiore is deploying telemedicine to provide access to psychiatrists via tablets when practice sites are not large enough to sustain full-time support.

Care reimbursement
Due to its risk-based contracts and extensive experience with underserved populations, Montefiore expects that it will be able to reduce readmissions and prevent patient utilization at more costly care sites across the care continuum.

Overburdened physicians and workflow disruption
Montefiore’s common EMR will make results readily available and easily transferable across practice sites and over time. Nurses will conduct universal screenings rather than physicians.

How is your medical group integrating behavioral health services into its primary care practices?

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