Adding Better Mental Health Care to Primary Care
A new era of behavioral health integration
• Science Update
What is Behavioral Health Integration?
Many people visit a primary health care provider (such as a doctor, nurse practitioner, or physician assistant) to treat physical diseases and injuries. However, it is also common for patients to see a primary care provider because of behavioral health issues including mental illnesses such as depression, anxiety, or problems with alcohol use. The primary care provider can treat mental disorders, particularly through medication, but that may not be enough. Historically, it has been difficult for a primary care provider alone to offer effective, high quality behavioral health care.
Integrating a “Collaborative Care” approach is one proven way primary care providers can enhance the quality and effectiveness of their behavioral health treatment. A team-based Collaborative Care program adds two new types of services to usual primary care: behavioral health care management and consultations with a mental health specialist.
How does Collaborative Care work?
The behavioral health care manager becomes part of the patient’s treatment team and helps the primary care provider evaluate the patient’s mental health. If the patient receives a diagnosis of a mental health disorder, and wants treatment, the care manager, primary care provider, and patient work together to develop a treatment plan. This plan may include medication, psychotherapy, or other appropriate options. Later, the care manager reaches out to see if the patient likes the plan, is following the plan, and if the plan is working or if changes are needed. The care manager and the primary care provider also regularly review the patient’s status and care plan with a mental health specialist, like a psychiatrist or psychiatric nurse, to be sure the patient is getting the best treatment options.
Collaborative Care has been found to improve quality of care, satisfaction with care, and both mental and physical health outcomes. Until now, however, it has been difficult for primary care providers to offer Collaborative Care, because most public and private health insurance plans have not paid for the main Collaborative Care services.
The Centers for Medicare and Medicaid Services (CMS) has adopted a new coverage policy for Medicare. On January 1, 2017, CMS will begin paying primary care clinicians separately for Collaborative Care services that they provide to patients who are being treated for a mental or behavioral health condition. There are other ways a primary care provider can integrate mental health services, but this policy change emphasizes Collaborative Care, including services from a primary care provider, a behavioral health care manager, and consultations with mental health specialists.
Why is this important?
Medicare’s new payment policy for behavioral health integration will have an immediate effect on those health care providers who are already offering mental health care to their clients. However, this new policy may have a much wider impact. It may increase the number of health care providers who offer behavioral health care to their Medicare clients and improve access to high-quality care for patients across the country. Currently, it is believed that only about 10% of patients with depression receive appropriate mental health care when visiting their primary health care provider1. Medicare’s new payment program may also encourage private insurance companies to offer similar payment options for integrating behavioral health care with primary care visits.
A more detailed analysis of the new CMS behavioral health integration policy was published online by the New England Journal of Medicine. The paper outlines various treatment models covered by the policy as well as payment schedules and training requirements for members of a treatment team. “This is a major step forward” said Michael Schoenbaum, Ph.D., senior advisor for mental health services, epidemiology, and economics at NIMH and co-author of the paper. “Making Collaborative Care and other effective care coordination more widely available via Medicare could improve the lives of millions of people with behavioral health conditions.”
1 Mechanic D. More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Aff (Millwood) 2014;33:1416-1424