Treating the Whole Person: Integrating Physical and Mental Healthcare

As the healthcare industry shifts toward value-based care, integrated care delivery models will become even more important.

By Medecision

A new trend is emerging in healthcare: integrating primary care and mental healthcare needs.  Measures of a person’s physical health—such as lab work, weight, blood pressure and diagnoses—should not be the only considerations in determining his or her overall health. Other factors, such as mental health, behavioral health, social determinants of health and economic issues, should also be considered.

Why? There’s a distinct link between mental health and physical health. For example, depression can increase the risk for chronic conditions such as diabetes, heart disease and stroke. This is especially true for Medicare and Medicaid populations—in one study, more than 50% of adults treated for a behavioral health condition had four or more comorbid conditions, according to research published in a January 2017 issue of Health Affairs.  Research indicates that more than 50% of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime—a clear indicator of the need to integrate primary care and mental/behavioral health.

A Framework for Integrated Care

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) developed a framework for integrated healthcare, outlining three categories of care between behavioral health and primary care providers.

• Coordinated care: In the coordinated care model, collaboration can vary between minimal communication and only under compelling circumstances, or take place periodically about shared patients. However, behavioral health practitioners and primary care providers maintain separate facilities and systems.
• Co-located care: In this model, behavioral health and primary care providers may share the same facility (but not necessarily the same office space). Providers collaborate, based on either the need for one another’s services or the need for consultation about difficult patients. These providers may share some systems, such as scheduling or medical records.
• Integrated care: This is the closest collaboration—and can look like a partially integrated practice or fully merged practice. In this model, providers communicate frequently, have regular team meetings, and have an in-depth understanding of each other’s roles and expertise.

2 Strategies for Integrating Physical and Mental Care

1. Focus on team-based care in primary care practices. As many as 80% of patients with behavioral health problems present in primary care clinics and emergency departments. Unfortunately, primary care providers often lack the training, resources and time to recognize and treat behavioral health conditions. This is why a team-based approach at primary care practices is so important.“Fully integrating behavioral health in primary care is the gold standard for care,” writes Sarina Schrager, MD, in a 2021 article for Family Practice Management. “One integration model uses a behavioral health consultant (BHC)—a psychologist, licensed clinical social worker, or other behavioral health professional—as a member of the health care team. It is not meant to be a handoff of care, but a team-based approach supporting the work of the primary care physician.”

   If a fully integrated model is unattainable, focusing on some level of integration—such as coordinated or co-located—can help improve outcomes. Payers can help with this, as well, by building robust networks that include behavioral health practitioners and connecting them with primary care providers and family medicine doctors.

2. Partner with community organizations. Physicians know that social determinants of health and economic issues can impact a person’s physical and mental health. In fact, 80% of physicians believe that the U.S. can’t improve health outcomes or reduce healthcare costs without first addressing social determinants of health. Physicians often feel ill-equipped to address these problems.However, physicians can partner with community organizations to help address patients’ social determinants of health. These tools can help providers and their care teams identify community-based resources:

• • Neighborhood Navigator: This free and easy-to-use database from the American Academy of Family Physicians provides access to community-based resources in every ZIP code in the U.S. The Neighborhood Navigator also includes tools to make and manage referrals and receive information about how patients use resources.
  • 211 Helpline: The 211 helpline made more than 23 million connections to help and resources in 2021. Although the helpline is most often used for individuals looking for community resources, providers can connect their patients with the helpline to identify resources to assist with specific problems.

Proof That Integrating Care Works

In 1999, Intermountain Healthcare, a not-for-profit healthcare system of 33 hospitals and 385 medical clinics headquartered in Salt Lake City, Utah, began integrating mental healthcare into its primary care clinics. The goal was to help patients achieve “mental wellness” as a critical part of their overall health, according to a July 2019 article by Lola Butcher in the American Hospital Association’s Trustee Insights newsletter.

“Patients come into their medical visit with many social and mental health-related issues—fatigue, not eating or sleeping, divorce, pain, violence—in addition to their chronic medical conditions,” Brenda Reiss-Brennan, Ph.D., APRN, mental health integration director at Intermountain Healthcare, told Trustee Insights.

In 2016, the Journal of the American Medical Association published the results of a 10-year study conducted by Intermountain Healthcare. Researchers observed more than 113,000 patients who received care during 2003–2013 in team-based primary care practices at Intermountain. The results were positive:

• Compared with patients in traditional practices, 46.1% of patients receiving care in team-based practices were diagnosed with active depression, compared with 24.1% in traditional practices.
• Of patients receiving care in team-based practices, 48.4% had a documented self-care plan to help manage their medical conditions, compared with 8.7% in traditional practices.

Not only does integrating physical and mental healthcare improve outcomes, but it can also save money. A 2014 report from the American Psychiatric Association suggests that “effective integration of medical and behavioral care could save $26–$48 billion annually in general healthcare costs.”

As the healthcare industry shifts toward a value-based care reimbursement model, integrated care will become even more important. But success requires collaborating with organizations outside your four walls to address the medical, behavioral and social determinants that impact the cost and effectiveness of care. At Medecision, we can help you work with providers across the community to deliver care where and when your patients need it. An integrated, personalized care experience helps you guide patients to the appropriate level of care and empowers them to better manage their own health. This proactive, collaborative approach to care management helps you improve care transitions, close gaps, and prevent unnecessary hospitalizations to achieve better outcomes.