Why is Behavioral Health Integration so Rare?

When we think of costly health conditions, the first that comes to mind for many is cancer. Treatment costs alone can bottom out even the best insurance plans. But did you know that behavior health conditions cost just as much per year as cancer? At a whopping $57 million per year, behavioral health conditions are one of the most costly health conditions in the United States today.

While behavioral health conditions are rampant, they often don’t get as much attention as their more physical counterparts. Research tells us that mental health woes like anxiety and depression can greatly worsen, or at the very least contribute to, chronic pain conditions and even affect the length of our lives – but these conditions are often not diagnosed and treated effectively, or, in conjunction with the other comorbidities of a particular patient with complex health needs. While we can go to our regular doctor, or primary care physician, for nearly all of our health concerns, there’s been a long time gap in treatment for conditions of the mind and soul – for those, we are inevitably rerouted to a psychiatrist. Part of the reason for this is that PCP’s are simply over-strapped – they don’t have the time, the education or the resources to definitively address a patient’s mental health concerns. That leaves many patients who seek treatment up a creek, so to speak.

We know that patients struggling with undiagnosed and/or untreated mental health conditions have greater utilization of hospital and medical services, much of which might be ultimately unnecessary and drive up costs for all. Not only do these patients seek care with more frequency, but they are also more likely to have hospital admissions – and readmissions. Once facet of behavioral health treatment is substance abuse treatment, which often requires inpatient treatment. Some patients may need additional stays to maintain their sobriety and everyone who seeks treatment will need some form of support network.

Considering how prominent these conditions are, why is behavioral health integration such a rarity?

One reason is that, for primary care doctors, there are restrictions on how much they can be reimbursed for when it comes to behavioral health treatment. Insurers may also pose limitations on what types of services can be utilized, and, in what situation they require preauthorization. These roadblocks negatively impact what primary care doctors can offer their patients, and drives patients out of their PCP’s office and into more costly specialist or inpatient settings.

Another hurdle for patients and providers is the everlasting stigma attached to mental health treatment and treatment for substance abuse. Until there is a cultural shift, a movement of acceptance that these are common ills of the human condition, an individual’s ability to get timely and effective treatment will be deeply compromised. Education – for patients, providers and payers – will be essential to curbing the stigmatization of these conditions.

Of course, for either of these initiatives to work, primary care physicians and behavioral health practitioners need to change the way they practice. ‘Change’ seems to be the buzzword for healthcare, but it has to be more than just an ideal. Active change requires teamwork, something that silo-operating healthcare systems have not long been a fan of. But bridging the gaps in communication between multiple layers of healthcare will be the difference between increasing, out of control costs – and truly sustainable healthcare.

So, how do you accomplish Behavioral Health Integration?

The organizations that have managed to begin their integration of behavioral health services and primary care have largely been either self or grant-funded. If your organization has the resources to do so, this would be the first route to take. For everyone else, there are valuable initiatives through the Centers for Medicare and Medicaid which support a healthcare system’s efforts to integrate these services. Through pilot programs, like the High Value Healthcare Collaborative, hospitals can test-run programs and communicate with other hospitals who are in the same boat – it might sound like sharing trade secrets, and perhaps it is. But communication – and learning from one another- makes all the difference in terms of innovation in healthcare.

Some individual states are also creating programs that will focus on the integration of these services – in Massachusetts, the One Care program takes care of dually eligible seniors by integrated their primary care and behavioral health needs. Other non-profits similar to this program have been cropping up nationwide in recent years.

How is your healthcare system bridging the gap between primary care and behavioral health services? What do you think it will take for these changes to happen?