Behavioral Health Integration Into Primary Care

An individual’s behavioral health can directly contribute to their physical health and vice versa. For example, pregnancy can lead to postpartum depression, substance use disorder may cause lung disease, medication for bipolar disorder can contribute to weight gain, and the list goes on. To holistically address patient wellness and improve patient outcomes, primary care providers must understand the inextricable link between their patients’ behavioral and physical health.

Integrating behavioral health into primary care requires collaboration between physicians, nurses, healthcare administrators, social workers, mental health professionals, and beyond. Only when all members of the healthcare system are acutely aware of the complex array of factors contributing to patients’ wellbeing can patient satisfaction and outcomes truly improve.

What is Integrated Behavioral Health?

Integrated behavioral health is a whole-person, patient-centered approach to healthcare that addresses all of the factors contributing to a patient’s symptoms. To accurately integrate behavioral health into their practice, primary care professionals must first understand what an integrated care model looks like.

For decades, primary care and health and human service professionals have worked in silos, with primary care professionals addressing physical health and health and human service professionals focusing on behavioral health. While this approach can be effective, it can also lead to inadequate treatment, health complications, and more.

Many patients go no further than their primary care provider for treatment — even when their provider refers them to a behavioral health specialist. As a result, many serious behavioral health conditions are left undiagnosed and untreated.

As the main source of medical care for many individuals, primary care physicians are uniquely positioned to provide more all-encompassing support through an integrated care model. Common examples of integrated behavioral care include offering a psychosocial assessment for depression before initiating a bariatric surgery, understanding a patient’s history with substance use before prescribing certain controlled medications, and determining a patient’s mental health risk before prescribing medications with serious side effects.

What are the Benefits of Integrated Behavioral Healthcare?

Both patients and healthcare providers stand to benefit from a whole-person approach to healthcare. The advantages of this type of approach include:

Improved Diagnosis

Because physical and behavioral health issues are often intertwined, understanding both aspects of a patient’s health can help physicians make more informed diagnoses. Take Rob, a fictitious patient, for example. Rob is experiencing some abdominal pain and decides to visit his primary care physician. After conducting several assessments and running some tests, his doctor is unable to identify the source of the pain.

What the doctor doesn’t realize is that Rob is also struggling with a substance use disorder. Had the doctor conducted a behavioral health screening and been aware of this information, he would have likely been able to diagnose Rob’s pain more quickly, as some substance use disorders can contribute to abdominal pain.

Financial Savings

If left untreated, behavioral health conditions often persist and can even intensify, requiring a greater investment of healthcare resources over the long run. By identifying behavioral health issues early, primary care providers can help significantly reduce healthcare costs. In fact, one Colorado project that integrated behavioral health services into primary care settings saved approximately $1.08 million in net savings for Medicare, Medicaid, and dual-eligible patients.

Integrated behavioral health services can also lead to significant savings for employers. Depression costs the U.S. economy upwards of $210.5 billion a year. Of those costs, an estimated 50% are the result of low productivity and disability-related absences in the workplace. By working to identify and address depression, primary care physicians can help patients better manage their conditions so they can remain employed and productive. 

Accuracy in Referrals and Follow-Ups

As the main medical contact for many individuals, a primary care provider’s diagnosis can define a patient’s trajectory throughout the entire healthcare system. When primary care physicians integrate behavioral health into their primary care practice, building rapport with clients and taking the time to understand them more fully, the success rate of referrals and follow-ups can improve dramatically.

For example, if a primary care physician conducts a depression screening and determines that their patient — an individual who works odd hours and speaks Spanish as a first language — needs additional support, they can connect the patient with a health and human service professional that speaks Spanish and has broader availability. This approach helps increase the likelihood that the patient will attend their follow-up and receive appropriate treatment.

Behavioral Health Integration and the PCHM

For many primary care professionals, initiating a behavioral health integration into their primary care clinic can be intimidating. How can they establish a more effective integrated care model without conducting a complex paradigm shift?

The path to success in behavioral health integration runs through the patient-centered medical home (PCMH). According to the U.S. Department of Health and Human Services (DHSS), the PCMH is “a promising model for transforming the organization and delivery of primary care.” Put simply, the PCHM is a collaboration-based healthcare delivery model designed to help ensure patients receive comprehensive, continuous care. The DHSS breaks the PCHM down into five functions and attributes:

1. Comprehensive Care

PCMH emphasizes the importance of creating an ecosystem of integrated healthcare, one that hinges on collaboration to function effectively. Under the guidance of the PCMH, primary care professionals are encouraged to connect their patients with a team of healthcare providers, including nutritionists, social workers, and pharmacists. These diverse specialists can work directly within the primary care clinic or as part of other clinics within the community to ensure patients have access to a comprehensive support network.

2. Patient-Centered

Patient-centered care is more than a healthcare buzzword — it’s an effective method of healthcare delivery. The PCMH is rooted in a patient-centered approach, encouraging primary care providers to work closely with patients and their families to develop care plans that reflect their unique needs, culture, values, and preferences.

3. Coordinated Care

PCMH deploys a team-based approach to healthcare, one in which hospitals, specialty care providers, and behavioral health organizations work together to coordinate a patient’s care. Coordinated care is especially important during times of transition, like when a patient is discharged from the hospital, to ensure the patient recovers appropriately.

4. Accessible Services

Per the PCMH, primary care teams must help minimize wait times for urgent needs, provide more flexible in-person hours, offer 24/7 virtual access to a care team member, and provide multiple channels of communication, including email and phone, to ensure all patients have access to the healthcare services they need.

5. Quality and Safety

Physicians who subscribe to the PCMH model are committed to improving the quality and safety of healthcare services through “ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management.” Combined, these efforts help provide all patients with safe, reliable healthcare.

Integrate Behavioral Health into Your Practice

A significant divide between primary and behavioral healthcare persists as patients seek services from primary care physicians while foregoing behavioral health ones. A collaborative, PCMH approach that integrates behavioral health into the primary setting can help close this gap and ensure all patients receive more comprehensive care, improving patient outcomes and increasing the efficiency of healthcare operations.

Fortunately, integrated behavioral health doesn’t require a major overhaul of your healthcare practice. Through a variety of minor adjustments to your primary care routine, you can make a lasting impact on patient wellness.

At Relias, our deeply rooted history in the behavioral healthcare space has allowed us to form meaningful industry partnerships and develop highly informative, evidence-based continuing education models. By working with leading organizations like the National Council for Behavioral Health, we’ve created numerous programs like Mental Health First Aid Recertification training. This program was designed to improve the ability for healthcare professionals to provide patients with the comprehensive care they need and deserve. To learn more about these resources, visit us at Relias today.