Integrating behavioral health care into a medical practice is a growing trend that makes perfect sense on multiple levels: one of which is that a significant percentage of ill people have a comorbidity.
The Agency for Healthcare Research and Quality recently released its Atlas of Integrated Behavioral Health Care Quality Measures. The atlas is designed to assist physicians and primary care medical practices in benchmarking and integrating behavioral healthcare into their system.
David Friend, MD, managing director at BDO USA, and a partner in the firm’s health care practice, says that integrating behavioral health care into a medical practice makes perfect sense on multiple levels.
“If I’m running a practice and I’m providing a better experience for my customers, if I’m treating them more rapidly, getting to the problem efficiently, helping my patients feel better faster, then by definition I’m providing a better medical service,” Friend explains. “If my patients have better outcomes because I treat them better, again, there’s going to be more demand for my services. And we’re moving into a world where more and more physician reimbursement will be contingent on producing better outcomes.”
The atlas was developed by Neil Korsen, MD, MSc, medical director, behavioral health integration, for MaineHealth. Korsen says there are several audiences that he had in mind when developing the atlas. Two primary ones are those practices that are already providing behavioral health care, and those that are thinking about it.
“I hear more and more interest in the integration of behavioral health and primary care,” Korsen says. “And a lot of the questions people ask have to do with, ‘Have you evaluated whether or not it’s working?’ The atlas gives them a way to think about how they’re going to measure that integration.”
Is the integration of behavioral health care in primary care medical practices a growing trend? Korsen believes it is, at least in part due to the development of patient-centered medical homes, and he expects it to continue.
“Across the entire state of Maine, part of the expectation of a patient-centered medical home is integration,” he explains. “I did primary care for 20 years, and I can’t imagine how you can take good care of people if you don’t have behavioral health as part of the team.”
Providing good medicine
Friend says one of the reasons to integrate behavioral health care into a medical practice is that a significant percentage of people who are ill have a comorbidity, or second health problem. He says that “the numbers I’ve seen in studies” indicate that 30% or more of patients with cardiac disease or other physical impairments also have a mental or behavioral health component.
“To treat one part of their problem without treating the other part is not good medicine,” he says.
Korsen agrees. He explains that “people are a package,” and that physical health problems and behavioral health problems almost always coexist.
“If you have diabetes, you’re trying to change your behavior,” he says. “If you have depression and diabetes, it’s likely your diabetes will be under poor control, which means you’re at risk for other health problems. So, you really need to address the behavioral as well as the physical aspects of a patient’s health.”
Friend suggests that the first step physicians need to take in integrating behavioral health care into their practice is to understand their own patient population. What are the issues these people are experiencing? What are their unmet needs? Is it an economically challenged population?
“Doctors should be thinking about the underlying population that they’re being asked to manage or treat,” Friend says. “The whole health care system is driving in that direction — reimbursement, and the way we think about managing care.”
The second step is to understand the resources that you, as a physician, can bring to bear to help your patient population. What resources do you need that you don’t have, and how can you obtain those?
“I believe you’re going to see more and more mental health providers that will be available to primary care practices,” Friend says. “You can partner with a behavioral health organization or other practice that offers to supplement your services with a nurse coach who’s available online.”
He believes it critical to take these steps because it will be rare to find a physician for whom behavioral health is not an issue.
Korsen agrees, and reiterates the important role a tool like the atlas can fill.
“We’re in an environment now in which we’re expected to measure what we’re doing in general, and to demonstrate the value of what we’re doing, which means being able to demonstrate the quality of care as well as understand the cost of care,” he says. “You have to measure to do both of those, and I think the atlas gives you the framework and some tools that will allow people to measure the value of integration over time.”