Primary Care Development Corporation’s (PCDC) recently released Points on Care issue indicates that integrating behavioral health and primary care improves overall health outcomes, particularly for those with comorbid physical and behavioral health conditions.
The data reviewed in the report revealed integrating care can address health disparities as well as reduce the cost of care. In a recent conversation, PCDC’s Clinical Lead and Senior Director of Partnerships, Andrew Philip, PhD, LP, presented additional context on the findings.
What are some key takeaways about this Points on Care issue?
At a very high level, this Points on Care reminds us of the need for advancing integration of services, whether we are talking about integrating physical health services for people receiving care in mental health and substance use treatment centers or addressing behavioral health needs in physical health settings, like primary care or pain clinics. The fact is, behavioral health conditions—things like depression, anxiety, and substance use disorders—are common, increasingly so throughout the pandemic.
The potential for having unmet behavioral health needs does not ‘go away’ because a patient is seeking care at a primary care practice or other medical setting. In fact, we know that those with chronic medical conditions, such as diabetes and hypertension, are even more likely to also have a behavioral health condition (and the reverse is also true). When we bring together physical and behavioral health services, we provide better care, especially for communities with more-limited access to care. If we are going to address the opioid epidemic, respond to the mounting behavioral health crises worsened by the stress and trauma of the COVID-19 pandemic, and heal communities reeling from years of oppression, we cannot pretend that our physical and emotional needs are not tied at the hip. You really cannot sustain much improvement on one if the other isn’t in good shape.
What did you find surprising within the report?
One thing frankly worries me, and another gives me hope. I’m very concerned with the levels of stress, anxiety, and despair we are seeing because of the pandemic and immense pain of this past year. When we dug deeper, a painful fact was confirmed: Black and Latinx communities—folks who have proven to be powerful and resilient despite lifetimes of disinvestment and oppression – are suffering at disproportionate rates, physically and emotionally.
Seeing the rise and spread of integrated, or at least co-located services, for physical and behavioral health gives me hope that we are starting to align our systems for better care (see the ‘Where is Integrated Care Happening’ section). While some areas of the country, particularly rural communities and parts of the Midwest really need greater investment in integrated care, I know things are starting to improve. PCDC works with partners like the Idaho Integrated Behavioral Health Network and the newly formed Arkansas Behavioral Integration Health Network to further grassroots (and quite impressive!) efforts to really spread the presence of integrated in areas that have not had the same density of services.
What recent efforts have the Clinical and Quality Partners team taken within behavioral health?
PCDC and the Clinical and Quality Partners Team have been beating the drum of integrated care for a long time, and this year we have been doing even more. PCDC partnered with the National Council for Behavioral Health and SAMHSA’s Center of Excellence for Integrated Health Solutions to deliver national training and discussions on applications of integrated care where they can be most powerful. Right now, we are halfway through a year-long series with The Center on integrating care to address sleep, which is something many of us have struggled with more than usual this past year. I highly recommend to check it out, and also visit the Center of Excellence to learn about a host of other integrated care initiatives underway right now, including a really robust learning community open for applications right now on implementing general health integration frameworks.
We recently launched another year-long webinar series funded by California’s Department of Health Care Serves with incredible support by Dr. Nadine Burke Harris, the state’s Surgeon General. It’s free and open to all, and focuses on the nuts and bolts of addressing adverse childhood experiences (ACEs) and trauma in small practices. This is crucial because small practices are often the only source of regular care, especially for small and low-income communities, yet they tend to get the least attention. Small practices are doing great things to address the emotional needs and experiences of patients, and this series highlights just that.
We are also working with over 50 behavioral health organizations here in New York City to advance the integration of primary care, mental health, substance use treatment and social services; supporting trauma-informed care implementation at a hospital network in Maine; developing tools for integrating care for LGBTQ in rural health centers; and more! As the recognition of behavioral health integration is growing, we are finding greater interest from partners to support this important movement.
What are next steps that the health care community should consider?
We wanted to be straightforward around what needs to happen in this Points on Care issue. We need to enhance support for integration where it is especially needed right now.
To do this, the whole system needs to pitch in, especially around financing. PCDC’s Capital Investment Team has been working to supply loans and other sources of capital to help integrate services, but this really needs to be supported by adequate provider reimbursement. An integrated system of care needs prospective, value-based payment models that provide the initial investment to really support integrated systems, and reimburse the provision of care at a rate that allows for the range of services needed to deliver whole-person care.
Finally, there is a clear need to direct specific efforts to neighborhoods that have been hit especially hard during the pandemic. They are reeling from the traumatic loss of loved ones, decimated local economies, and what communities will start seeing as the effects of deferred care (undiagnosed health conditions, disruptions in monitoring of health conditions, and delays in procedures) that had to be delayed during the pandemic. Not only will providers be playing ‘catch up’ to get everyone the care they have needed, but all of us are now dealing with an increased need to remedy the effects of this incredible time.
As members of the integrated care community – payers, providers, researchers, policymakers, and system supports – we have got our work cut out for us, and the roadmap has never been easier to read.
Points on Care: Rising Need for Behavioral Health Integration (2021)
In this issue of Points on Care, PCDC reviews the most recent information on primary – behavioral health care integration, including latest data on integration’s promising impacts on clinical outcomes and cost reduction. The brief also presents emerging data on rising behavioral health needs amid the COVID-19 pandemic.