Integrated care plan helps primary care physicians address mental health

WASHINGTON — According to Brenda Reiss-Brennan, PhD, mental health integration director for Intermountain Healthcare, the first step toward integrating behavioral health into primary care is to stop thinking of patients with mental health issues as “other.”

“I think the beginning of our downfall is that we see and organize patients according to ‘us and them’ and ‘these patients,’ and thinking differently about people having certain diseases and conditions,” Reiss-Brennan said during a presentation at the U.S. News & World Report’s Hospital of Tomorrow Forum. “That has really gotten in the way of building care delivery systems and communities that treat the whole person.”

At Intermountain Healthcare, a Utah-based integrated delivery system comprising a large medical group, various care clinics, and an insurance plan, integrated care has been a priority for decades. Reiss-Brennan said Intermountain has been researching ways to effectively incorporate behavioral health into primary care practice. She said much of this research has focused on determining the needs of patients with behavioral health issues and understanding the barriers of primary care doctors to treating these patients.

“We’ve done enough research that we’ve figured out what is of value to patients,” she said. “They want to be treated as whole persons, they want to come to our clinics and hospitals and see kindness and respect. They want us to get to the root of the problem, and they want us to make it affordable. They want it to be successful.”

She said when patients come into any of Intermountain’s 16 care clinics across the state, the system treats every patient that walks in the door, regardless of condition or health plan.

“We established three principles — we treat all conditions or concerns of the patients or families coming in, we treat all patients regardless of their ability to pay, and we connect everyone together.”

Reiss-Brennan said Intermountain has advanced its “culture of learning” through 15 years of self-study, which began by listening to the burdens and concerns of primary care providers within the system. While practitioners seemed comfortable with handling a wide variety of chronic conditions, they expressed concerns about issues such as substance abuse, depression or domestic violence. She said the company responded by building an improved work process focused on physician teamwork and a seamless patient experience. She acknowledged that this has not been easy.

“We can do this because the culture has changed, and it has taken a really long time to change physician practices,” she said. “They are bears. They have one way of doing things, and that’s how they do it. To get them into a group, and have them work as a team and get paid as a group has not been easy. By putting a team around the primary care physician, and having that team be effective by giving data back to them, we’ve been able to achieve this goal.”

She said providing data about what is being achieved — better patient outcomes, reduced practice burdens, fewer ED visits — has been valuable to physicians.

“We’ve been able to build on that data, and our patients are being well cared for in primary care, and we’ve reduced ambulatory-sensitive measures, ER visits and hospitalizations,” she said. “Physicians are able to feel comfortable with mental health, so now mental health is normalized.”

She said through studies tracking mental health patients in integrated clinics and comparing them with patients seen in other settings, Intermountain has learned that continuity and familiarity are the keys to all facets of health.

“We’ve found that in patients that can stay with our system and have a continuous relationship over time, their diabetes is better managed, their depression is better managed, they are not in the hospital and they are not in the ER,” she said. “This is with all payers, not just our health plan. This continuous, connected relationship with the delivery system over time is what actually impacts the outcomes.” — by Jennifer Byrne