Integrated care is the most impactful solution for addressing the worsening mental health crisis. Yet, most patients do not receive effective treatment at their primary care practice. As the most effective setting to receive care in the United States, we can do better.
Integrating behavioral health in primary care is proven to enhance access to care, drive improved patient outcomes, reduce costs, and improve overall patient experience. Unfortunately, uptake has been slow and is made more difficult by adoption barriers including high billing difficulties, limited therapist availability, and more.
Slow adoption prompted eight of the nation’s leading physician organizations (including the American Medical Association, the American College of Physicians, and the American Psychiatric Association) to urgently call for accelerating behavioral health integration (BHI) in primary care to meet demand.
As the market leader in behavioral health integration in modern primary care, we asked a few members of evolvedMD’s executive team and our primary care partners from HealthyU and HonorHealth for their reactions to the organizations’ solutions and steps to widespread adoption.
Physicians Can’t Do It Alone. What Are Practical Solutions?
The collective outlines five solutions for payers to support widespread BHI adoption. See reactions from evolvedMD executives and Dr. Lauren Havard at HealthyU Clinic below the list:
- Expand coverage and fair payment for all stakeholders utilizing BHI models;
- Evaluate how and when to apply cost-sharing for integrated services (whether delivered in person or via telehealth)
- Assist primary care practices by offering technical support, provider training and regional sharing of resources
- Minimize and/or eliminate utilization management practices for BHI services
- Launch whole-person, employer-based behavioral health programs with intentional culture-focused work to destigmatize behavioral health.
Dr. Lauren Havard, Medical Director at HealthyU: “Physicians need better support for their patients regarding their behavioral health needs. This should include: easy access to behavioral health services (psychiatry, psychology, social workers, therapists, medication, treatments, etc), a way to communicate efficiently and effectively with the behavioral health team and vice versa. Physicians need the capability to expedite critical behavioral health situations in a manner that helps the patient but does not put more stress/burden on the physician and their team members. This is all comes down to communication and access to care and these two things should be at the forefront of behavioral health and patient care. This is the bridge that is formed when you implement BHI.”
Kim Ho, Director of Sales: “Physicians need this support as much as we all do. Behavioral Health Integration allows them to focus on their patient’s physical health needs and bring in another team member that can expertly support their patients’ mental health.”
Sentari Minor, Head of Strategy: “Physicians are often the first ones to spot and see behavioral health issues but simply are not equipped to be effective. This is both a disservice to the provider (the physician) and the patient. Integrating behavioral health, on site, can allow providers to feel like they are doing what’s right for their patients while the patients get the care that they need. Working together, holistically, collaboratively, and in sync will create communities that are healthy and thriving.”
Erik Osland, Co-CEO and Co-Founder: “Each practice needs to complete an assessment where they ask themselves the following questions:
- Are we committed to investing in the integration of behavioral health services at our practice site? This includes time, energy, and resource allocation.
- Do we have expertise in managing and operating a behavioral health component?
- Are we committed to the workforce development of this new behavioral health staff?
- Are we committed to being fully integrated within the next 12-24 months?
If the answer to any of the questions above are no or maybe, then outsource. There are many national groups now providing comprehensive and high-quality integrated services. Do your research, find a group that aligns with your values and hire them.”
What Can Federal and State Policymakers Do to Support Widespread Adoption?
The collective outlines four critical steps. See reactions from evolvedMD executives and Dr. Lauren Havard at HealthyU Clinic below the list:
- Provide long-term sustainable funding opportunities for training and education on implementing BHI services
- Raise payment levels for BHI services for all stakeholders in federal and state coverage programs;
- Work with health plans and coverage programs to limit utilization management review practices, enforce behavioral health parity laws, and strengthen network adequacy regulations; and
- Increase federal funding with the aim of growing the behavioral health workforce especially for those who practice in underserved areas.
Dr. Lauren Havard, Medical Director at HealthyU: “There should be access to behavioral health care that is affordable for everyone. Also, more initiative should go toward recruiting for this field as there is a long waitlist to see behavioral health specialists. Also, a policy should be in place at every level that allows people to access behavioral health when needed at any point in their careers without judgement. Behavioral health needs to be talked about more and brought to the forefront of conversations, so it is no longer looked at as a taboo.”
Kim Ho, Director of Sales: “Expand CoCM coverage and increase Medicare and Medicaid reimbursement rates so all patients regardless of their background have access to critical behavioral health care.”
Sentari Minor, Head of Strategy: “Expand collaborative care funding, provide incentives for primary care practices and groups to integrate, and make it a public health priority.“
Erik Osland, Co-Founder and Co-CEO: “I have a few thoughts:
- Uphold established parity laws and mandate coverage from both commercial and Medicaid plans in the state. Less than half of the state Medicaid plans currently reimburse for integrated care, this is unacceptable.
- Increase payment rate and then mandate that these rate increases are applied to clinical salaries.
- Break down barriers to care that limit frequency of behavioral health visits in primary care. Current CoCM codes effectively limit a patient to one visit per month. Why not create an annual “global limit” instead?
- Create incentives: Provide startup grants for each practice. A nominal amount of $3,000-$5,000 in grant funds per primary care provider would essentially allow most practices to cash flow the integration.
You can also incentivize high-level care. Increase physical health codes by 1-2% for those that adopt integration and treat both physical and mental health in one setting.
Second, over a time horizon shift from encouraging and incentivizing integration to penalizing those providers that do not adapt to a whole person model. We saw this play with EMR adoption, and it worked — do the same for integration. For example: Incentivize from the current year to 2025, then begin to roll back physical health E&M reimbursement for those sites that elect not to integrate.”
Why Should Primary Care Practices Adopt BHI Now?
Fully integrating behavioral health in primary care is the gold standard for care, according to the American Academy of Family Physicians. Benefitting both patients and providers, our unique approach to behavioral health has created lasting change for our primary care partners. We can’t thank them enough for their partnership and commitment to reimagining behavioral health for all by increasing access to care and driving improved outcomes.
Dr. Lauren Havard, Medical Director at HealthyU: “When behavioral health is integrated into primary care practices, it not only helps patients get the care they deserve, but it helps the providers, team members and hospital systems better manage patients and better allocate resources. When you are able to allocate resources in a more effective way, you provide better care all while saving money which is helpful to everyone involved in the process.”
Dr. Kim Olson Gibbs, Associate Chief Medical Officer at HonorHealth Medical Group: "Adding a BHM into our primary care office has been so beneficial for our patients but also for our office as a whole. For our patients it means cost effective immediate access to mental health care. For our staff it means that we can feel confident that our patients’ needs are being addressed by a compassionate BHM (how do we know? We work with her in the office—we have coffee together, eat lunch together, she is a member of our community in every sense of the word)."