Physician groups are pushing for more complete integration of behavioral health and primary care

The stress created by the COVID-19 pandemic is heightening the need for “whole face care,” they say

Eight leading physician organizations are calling on health care policymakers and payers to adopt policies aimed at more fully integrating behavioral health services into primary care.

In an article published online July 7 in Health matters, organizations urged primary care systems to embrace a “paradigm shift” in order to accelerate the adoption of behavioral health integration (BHI) in physician practices. The organizations say they have come together to create the BHI Collaborative to help achieve their goal.

The article notes that behavioral health conditions are a major contributor to disease burden and that depressive and substance use disorders are among the top 10 causes of death and disability in adults. Additionally, up to 70% of primary care visits include a behavioral health component.

“A holistic, evidence-based integrated approach within primary care settings that focuses on the well-being of the whole person through all stages of development, including the implementation of behavioral health screening and tools to accommodate the intensity of services … that are standardized and normalized, can help people receive treatment earlier and at the right level of care,” they write.

They add that such an approach would have the added benefit of improving job satisfaction among physicians and other members of the care team, “as they report feeling less burned out knowing they can more fully care for the most pressing needs of their patients’.

The article acknowledges the obstacles to realizing the collaboration’s vision, including high start-up costs, low reimbursement rates, complex and burdensome billing requirements, siled data, and lack of manpower. The authors suggest five steps payers can take to address them and encourage more BHI adoption practices, including:

  • Expanded coverage and equitable payment for BHI models that facilitate care management and care transitions for patients with behavioral health conditions;
  • Assessing how and when to implement cost-sharing for integrated behavioral health services delivered in-person or via telehealth;
  • Offering technical support and provider training to assist primary care practices with BHI;
  • Minimize or eliminate prior authorization and other practices to manage the use of BHI Services, and
  • Design, pilot and launch employer-based behavioral health programs that give employees immediate, direct access to behavioral health resources and providers

In addition, the collaboration calls on federal and state policymakers to:

  • Provide long-term sustainable funding opportunities for primary care practices to support training and education to implement BHI services
  • Increasing payment levels for BHI services so that practices can sustain them;
  • Work with health plans and coverage programs to limit utilization management review practices, enforce behavioral health equity laws, and strengthen regulation of network adequacy; and
  • Increase federal funding to expand the behavioral health workforce

They also push for the inclusion of telehealth and other digital tools in BHI care models, “as long as they augment, not replace, the longitudinal doctor-patient relationship.”

Members of the BHI Collaborative include: American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Medical Association, American Osteopathic Association, and American Psychiatric Association.

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