Behavioral Health Integration
The case for integrating primary care and behavioral health — a “one-stop shop” where a team of providers administer care by considering mental, physical, and social needs — is a powerful one.
Primary care providers reach only a fraction of those requiring services for depression, anxiety, and other common behavioral health conditions. Meanwhile, those living with serious mental illness (SMI), who are often seen in behavioral health settings, typically lack access to adequate primary care. Integrating primary care and behavioral health services is increasingly recognized as a critical component of whole-person care and improved health outcomes.
PCDC is proud to have been a main financier for several visionary projects promoting care integration both locally and nationally. PCDC believes that the health care system should treat patients as whole people, deserving of person-centered care in a comfortable, accessible, and equitable environment. This is the future of primary care.
Our Policy Priorities
REDUCING BARRIERS TO INTEGRATION
Streamline integrated facility requirements and create financial incentives for integrated care reimbursement models.
New York is one of many states that has distinct facility licenses and building requirements for providers and health centers to receive Medicaid reimbursement. PCDC found several barriers to the current state approaches intended to reduce the complexity of these requirements, including limited uptake of the DSRIP integrated care license, utilization thresholds that do not meet the needs of larger health centers and practices, service/billing limitations, and difficult administrative requirements. PCDC urges states to simplify these licensing requirements in order to reduce these detrimental barriers.
Additionally, regulatory guidelines prohibit billing for a behavioral visit on the same day as a primary care visit when providers use the same provider number. Furthermore, current Medicaid and Medicare billing structures do not allow for reimbursing core integrated care services such as provider consultation time and care team meetings, and value-based payment does not yet fully cover these and other integration costs. Delivery system payment reform must meaningfully adhere to the needs of integrated care models.
BUILDING PROVIDER CAPACITY
Enhance provider education to promote bi-directional care.
Training and certificate programs must be developed to support the pipeline of qualified staff needed for integrated care. Clinical training must include interprofessional care competencies to ensure a foundational understanding of primary and behavioral health care. Additionally, the integration process itself should incorporate cross-discipline training and continuing education. This training and awareness create an environment where appropriate questions are asked of patients and warm hand-offs allow for continuity of care.
INNOVATING CARE DELIVERY
Develop integrated systems for data sharing and promote a team-based approach to care.
Patient privacy, levels of clinical access, and bi-directional information sharing are frequently cited by providers as concerns when considering best practices. PCDC advocates for the federal government to consider integrated care needs when certifying electronic health records and to promote greater interoperability between platforms and providers. Additionally, delivery system initiatives should streamline and reduce duplicative systems and reporting requirements across funding streams (e.g., DSRIP, Health Homes) and payer types (Medicaid, Medicare, commercial plans).
Integrated care initiatives should define effective bi-directional care transitions and build the necessary schedules, processes, and organizational culture to ensure access and information sharing. Importantly, policies should establish joint responsibility for key physical and behavioral health outcomes and metrics. Developing, monitoring, and reporting on shared metrics and outcomes can help foster shared goals and movement towards coordinated results.
Through research and interviews with successfully integrated facilities, PCDC compiled recommendations to serve as a framework for providers, policymakers, and other stakeholders to consider as they implement and advocate for programs and policies that support behavioral health integration.