Integrating primary care and behavioral health

In the move toward value-based care, primary care physicians are being encouraged to treat their patients holistically, including not only their physical health but also their mental and behavioral health. Many primary care practices include mental healthcare, but very few have integrated behavioral healthcare providers.

The traditional fee-for-service model may have made behavioral care cost prohibitive for primary care physicians. The Commonwealth Fund found that “patients with behavioral health problems—which include both mental illness and substance abuse disorders—cost two to three times as much to care for as those without them.”

Often, physical health is connected to behavioral health. Depression, drug use, and other factors can contribute to or exacerbate chronic medical conditions. An editorial in Journal of the American Medical Association recently pointed out that, “Integrated [team-based care] is clearly superior to [traditional management] for patients with complex mental illness and chronic medical disease…It would be unethical…to randomize this type of high-risk patient to usual care when integrated care has been shown in many studies and many types of health systems to be superior to traditional care.”

Behavioral health can impact a primary care physician’s patients’ ability to contribute to their own physical healthcare plans. Parinda Khatri, Ph.D., chief clinical officer at Cherokee Health Systems, notes that patients who are depressed, for example, are not as likely to participate in a plan to reduce their blood pressure. She says that “If you give someone a prescription and ask them to take it regularly, you’ve asked them to change about seven health behaviors. All of that requires significant health behavior change.”

In addition to the health ramifications for the patients, reimbursement for the primary care physician’s practice will soon depend on effective integrated treatment plans that include behavioral health as well as physical and mental health. Treating the whole patient will become a significant factor in the new value-based care model.