Integration with Primary Care

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Integrated behavioral health provides care in a single setting, often primary care, for both medical and behavioral health conditions. Primary care and behavioral health clinicians collaborate to provide person-centered care for a specific population. Care can be focused on mental health and substance use conditions and their impact on physical health. Integrated behavioral health also focuses on ineffective patterns of health care utilization and life stressors and crises. 1 

Providers practicing integrated behavioral health care recognize that both medical and behavioral health factors are important parts of a person’s overall health. Medical and behavioral health clinicians work together as a team to address an individual’s concerns. Care is delivered by these integrated teams in the primary care setting unless people request or require specialty services. The advantage is better coordination and communication, while working toward one set of overall health goals.2 

Nearly one-third of individuals who are dually eligible for Medicare and Medicaid have been diagnosed with a serious mental illness, such as schizophrenia, bipolar disorder, or major depressive disorder, a rate almost three times higher than for non-dually eligible Medicare beneficiaries.3 Dually eligible beneficiaries with behavioral health conditions often must navigate different systems of care for their physical and behavioral health needs, as well as different systems of coverage under Medicare and Medicaid. Fragmented physical and behavioral health care, delivered across multiple providers and funding sources, can decrease access to care and lead to poor health status.4 

Resources for Integrated Care has developed resources for providers and plans serving dually eligible individuals on how to integrate behavioral health treatment into primary care settings. These resources include a continuum-based approach for integrating care that allows practices at any stage of integration to assess and advance their integration efforts. Organizations that move along the integration continuum may be able to improve the quality of care they provide while increasing the efficiency of care delivery and reducing health spending.

1 Peek, C.J. & the National Integration Academy Council. (2013). Executive Summary–Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. AHRQ Publication No.13- IP001-1-EF. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from: http://integrationacademy.ahrq.gov/sites/default/files/Lexicon_ExecSummary.pdf.

2 The Academy Integrating Behavioral Health and Primary Care, What is Integrated Behavioral Health?  https://integrationacademy.ahrq.gov/about/integrated-behavioral-health.

3 Congressional Budget Office. “Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies.” June 2013. Available at: https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/44308dualeligibles2.pdf. This report classified Medicare enrollees as having a mental illness if they had a diagnosis from the previous year of schizophrenia; major depressive, bipolar, and paranoid disorders; or other major psychiatric disorders.

4 Medicaid and CHIP Payment and Access Commission. “Integration of Behavioral and Physical Health Services in Medicaid.” March 2016. Available at:  https://www.macpac.gov/wp-content/uploads/2016/03/Integration-of-Behavioral-and-Physical-Health-Services-in-Medicaid.pdf.  Cited S.P Melek, D.T. Norris, and J. Paulus. Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry. Milliman, Inc., and American Psychiatric Association, 2014. Available at http://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/.

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