For a number of years, the folks in the trenches have been saying it’s important to integrate behavioral healthcare and primary care – for cost savings, but most importantly for patients.
Recent research shows that people with mental illness have an average life expectancy of 53. They may have been dutifully going to a community mental health center to get medications for their mental illness, but they have been completely disconnected from primary care.
“For the last 10 years, all the policy activity has focused on expanding the capacity for identification and treatment for behavioral health disorders within primary care. That is still an important goal and a very wise policy direction,” said Chuck Ingoglia, vice president for public policy at the National Council for Community Behavioral Healthcare. “More recently, there’s also this recognition that we’ve got to increase the access to primary care for people with mental illness and substance use.”
The Affordable Care Act has specific provisions for integration, and government agencies, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have issued grants to facilitate integration. But integrating is easier said than done.
The Shawnee Mental Health Center, serving three counties in Ohio, received grants from the Health Foundation of Greater Cincinnati and SAMHSA to integrate. SMHC chose to hire its own primary care staff rather than partner with another organization.
The biggest integration challenges facing SMHC are lack of understanding between behavioral health clinicians and primary care clinicians and proper reimbursement.
“The behavioral health side has its own language and primary care has its own language and sometimes there have been clashes – one side not understanding what the other one means,” said Cynthia Holstein, SMHC’s director of standards and certification. To resolve those “language” barriers, SMHC provides education and training to its staff.
While adding primary care services has brought in new revenue to SMHC, the organization can’t see enough people on a fee-for-service basis to be financially successful. Don Thacker, SMHC’s executive director, said that for financial success to happen the payment system will have to refocus to one that values care management and coordination resulting in better patient outcomes.
As SAMHSA hears how its grantees are progressing, it’s finding that, for patients, care coordination is the right direction to move in when considering models for integrated care programs. But beyond that, the organization doesn’t yet know what works best, said Trina Dutta, a public health analyst at the Center for Mental Health Services, part of SAMHSA.
“We’re really interested in just understanding what makes sense,” she said. To that end, SAMHSA is evaluating their grantees’ projects, seeking to learn if integration actually works, if health outcomes improve and what the core features are in integration models that yield the best health outcomes.
Dutta expects initial costs to the healthcare system as a whole to go up as behavioral health and primary care integrate because use will increase. However, she said, over the long term those initial costs will be offset or at least cost-neutral.