Most patient-centered medical home pilots have focused on primary care, but in Maine the proposed approach would integrate behavioral health services, in a bid to make physician practices more efficient and attentive to their patients.
“Everybody is struggling to unify the mental and physical component,” said Wendy Smith, network manager for United Behavioral Health in Portland, Maine. “Why do (patients) have to go to two different (providers) to solve one situation?”
In a patient-centered medical home model of care, or PCMH, primary care physicians partner with patients to understand their needs, manage their healthcare and facilitate care from other professionals. The PCMH emphasizes preventing disease, improving care of chronic conditions and behavioral health support education.
The behavioral health component of a PCMH has been overlooked, Maine organizers believe. For instance, mood disorders are the seventh most costly, and second most disabling, health condition in the U.S. Severe and persistent mental illness patients have higher rates of death than their cohorts in the general population.
Fifty primary care providers applied for the Maine PCMH pilot integrating behavioral health, but only 20 will be accepted.
Behavioral health/mental health is central to overall health, and physical health is also central to mental health, said Wesley Davidson, chief executive officer of Aroostook Mental Health Services, Inc.
The inadequacy of behavioral health services is rooted in the organization and delivery of healthcare, he said. Both physical and behavioral health systems are fragmented, compartmentalized, and ineffective.
“Pilots aren’t always well thought-out,” said Davidson. “Primary care practices typically can’t care for patients with behavioral health services and vice-versa.”
Most providers are unable to transform their practices without viable and sustainable payment for the desired services in a PCMH. But employers and payers will reimburse for PCMH services because primary care demonstrates value and saves money.
“The (amount of money) that they get (in a pilot program) has to be enough to truly change care,” said Lisa Letourneau, executive director of Quality Counts, a regional healthcare collaborative in Maine. “Doctors are the only profession we expect to do all kinds of non-doctor stuff. The pilot must include a better use of existing staff.”
Elizabeth Mitchell, chief executive officer for the Maine Health Management Coalition, said her organization has employers whose budgets are unsustainable. “We need a system redesign to see the importance of integrated care,” she said.
Aetna, UnitedHealth and Anthem insurance companies plan to implement “parity” in their reimbursement system, acknowledging that the PCMH setting with integrated physical and behavioral health services aims to improve patient health all around and boost organizational performance. Payers expect PCMH to improve the financial status of a practice.