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Researchers provide insight into the 'paradigm shift' of integrating behavior health, primary care

Themes such as changing management strategies and using targeted data collection should be addressed when making the fundamental change of integrating primary care practices with behavioral health, according to research that recently appeared in the Journal of the American Board of Family Medicine.

“Integrating behavioral health and primary care presents a challenge above other levels of practice transformation because it represents a paradigm shift in how health care is delivered and viewed: physical and mental health are treated together to address whole person health,” Stephanie B. Gold, MD, of the department of family medicine, University of Colorado, Aurora, told Healio Family Medicine. “Those who have risen to this challenge have wisdom to share with others who might follow in their footsteps.”

According to the researchers, 67% of adults with behavioral health disorders do not get sufficient treatment. They wrote that although incorporating primary care and behavioral health has fallen behind other such efforts, there are new incentives for doing so.

“New payment structures and delivery models that support the integration of [primary care] and [behavioral health] are emerging, facilitating the movement toward integrated care as part of the drive to achieve the Triple Aim of better patient experience, lower costs, and improved population health,” they wrote.

Integrating behavioral health care with primary care physicians incorporates cost-effective and systematic approaches to address topics such as , stress-related physical symptoms, life crises and stressors, and health behaviors and how these factors affect chronic medical illnesses, substance use conditions, and mental health, the researchers wrote.

Eleven practices in Colorado representing both rural and urban areas, as well as practices of different sizes, took part in The Advancing Care Together (ACT) study. For 3 years, these practices considered and tried out their own strategies for integrating primary care and behavioral health, using the following principles: suitable workforce preparation, sufficient staffing ratios and adjustable scheduling, integrated electronic health records, external financing to cover related costs, the level to which services are delivered, the design of the workspace, the path to patient changes, the care pathways for differing degrees of illness and a shared mental model.

At study’s end, practice leaders, whom the researchers called innovators, met for 2 days to discuss their experiences. This led to the development of what researchers called “key themes”:

• use targeted data collection applicable to integrated care to drive improvement and impart accountability;
• come up with a change management strategy of ongoing evaluation and course-correction;
• assemble inclusive, empowered teams to provide the foundation for integration;
• specify protocols and relationships from the beginning, understanding they will evolve; and
• formulate integrated care as a necessary paradigm shift to patient-centered, whole-person health care.

“Existing integrated care checklists provide the ‘what’ that practices must accomplish; the themes … contextualize the ‘what’ with the ‘why’ and ‘how.’ The themes mirror, in a complementary fashion, recently articulated pathways to integrated care,” researchers wrote.

Gold addressed primary care physicians and family physicians who might not want to integrate.

“When behavioral and physical health conditions are treated together in a medical setting, health outcomes and utilization improve. Most patients with behavioral health conditions are seen in primary care, presenting an opportunity to replace fragmented care with delivery systems that holistically address patients' needs,” she told Healio Family Medicine. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.