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Integrating behavioral health and primary care: keys to success in value-based care


Mental health care access remains a problem for patients, but deliver models and services are evolving.

physician consoling patient: © Chinnapong - stock.adobe.com

© Chinnapong - stock.adobe.com

Though by many measures and behaviors we’ve shifted to the endemic phase of COVID-19, our health care system continues to grapple with a crisis exacerbated by the pandemic: mental health. The ongoing difficulties and uncertainties driven by the pandemic led to a worsening of many pre-existing mental health issues and the emergence of new ones. Indeed, recent research found thatthough more people are demanding mental health services and the number of related visits is increasing, 42%of adults with a desire to see a mental health professional have still not done so, pointing to patient access issues.

Given the challenges with access to behavioral health care, many primary care physicians (PCPs) have become well-versed in the treatment of certain behavioral health conditions such as depression or anxiety. This is particularly true in rural areas where mental health services are scarce, and PCPs are relied upon for treatment and often serve as the primary delivery pipeline for mental health services. For patients with more complex conditions or treatment failures, however, the access challenges remain. The good news is behavioral health care delivery models and services continue to evolve.

Nele Jessel, MD

Nele Jessel, MD

One opportunity to improve access to behavioral health services is through telehealth. Telehealth services were widely adopted during the pandemic and are now a routine part of many primary care practices. Additionally, health care operators that specialize in virtual behavioral health care have entered the market in the last several years, and several payers have partnerships with virtual health care service provides to facilitate patient access to these services. A 2022 consumer survey revealed that 25% of respondents have attended a telehealth visit to address a new mental health concern and 23% were more likely to seek out mental health support because telehealth was an option. This data points to telehealth removing barriers for patients, making health care more convenient and easily accessible. By increasing accessibility, patients are more likely to seek the health care they want and need.

Another option of addressing access to mental health care is to provide integrated behavioral health services alongside primary care. Such an approach can significantly improve accessibility to treatment and eliminate the need for separate appointments or long wait times for specialists. Moreover, coordinating care can contribute to significantly reducing the stigma often linked to seeking mental health care by offering comprehensive services in a familiar health care setting.

Managing the cost of integrated health care

Integrating behavioral health into primary care settings can be resource-intensive for physician practices and may be cost-prohibitive in a fee-for-service world. This is different for practices participating in value-based care (VBC) contracts: addressing patients’ mental health conditions has been shown to positively influence total cost of care, hence the financial benefits of the integration could ultimately outweigh the challenges for those adopting quality-based payment models.

Due to the rise of medical inflation and stagnating reimbursement rates, relying solely on fee-for-service (FFS) models in today’s highly competitive market may not be enough to sustain existing business, and is unlikely to cover the cost of integrating behavioral health. According to research from the Health Care Payment Learning & Action Network, the percentage of health care payments tied to alternative payment models (APMs), which include VBC, increased to more than 40% in 2020, highlighting steady year-over-year growth. With the health care reimbursement structure continuing the shift from volume-based to quality-based, practices that don’t embrace APM contracts risk losing market share and revenue.

Integrating behavioral health into primary care has the potential to enhance the management of chronic medical conditions, provide patients with more opportunities for treatment, reduce the cost of care, and empower providers to handle mental health conditions with more flexibility. Transitioning toward VBC and integrating behavioral health care into primary care can help practices control costs and create a more resilient, accessible, and cost-effective health care system for the future.

A board-certified clinical informaticist and pediatrician, Nele Jessel, MD, is chief medical officer at athenahealth.

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