Adding Value With Behavioral Health

Many of your most challenging claims and cases likely present a behavioral health component. BHM offers a reviewer network with the most sub-specialties. Six of the top 10 largest health plans entrust BHM for behavioral health peer reviews. Click here to learn more.

Behavioral health mixes into many aspects of patient care. Whether a root cause, a symptom, or part of the healing process, mental health issues increase the complexities of whole-person treatment and reimbursement. Understanding the many levels of impact will improve service design, delivery, and case processing — and ultimately adds value to patient care.

Behavioral Health

The following is paraphrased from a Kaiser Health News report. See the copyright note below.

Even on her worst days, Tracy Young keeps her appointments at the San Fernando Mental Health Center, where she says counseling and medication hold her depression and schizophrenia at bay. She is far less faithful about her physical health: despite painful arthritis, a persistent backache, and a family history of cancer, she had not seen a medical doctor in more than three years until this month.

People with severe mental illness are more likely to die prematurely than those without, often from treatable chronic diseases — in part because many, like Young, don’t receive regular medical care. Some are uninsured or can’t find doctors who take their insurance; others avoid traditional medical offices because of stigma or discrimination. Even when they do see a physician, that doctor rarely communicates with their mental health provider, and experts say the resulting lack of coordination can drive medication problems, higher costs, and gaps in care.

Providers are now beginning to bridge that divide, forming partnerships aimed at improving patients’ physical and mental health while reducing costs. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida.

Garrett Moran, who directs an academy on the integration of behavioral health and primary care for the federal Agency for Healthcare Research and Quality, described a sea change in attitudes and argued that integrating behavioral and physical health care is essential to bending the cost curve. The old model of simply referring a patient with mental illness to a primary care doctor doesn’t work, he said; patients instead need close, coordinated monitoring by both providers.

A RAND Corporation review of 56 such programs around the country found that patients who received primary care at mental health sites had better diabetes and hypertension control, though people with obesity and those who smoked showed no improvement.

At the Institute for Family Health, the focus is on promoting healthy behavior among people with severe mental illness, with medical assistants offering wellness coaching and primary care providers helping patients quit smoking and lose weight, said senior vice president Virna Little. She noted that when someone uses smoking as a coping mechanism for anxiety, providers have to address the anxiety alongside the smoking cessation.

Linda Rosenberg, president and CEO of the National Council for Behavioral Health, said it is often hard for people with mental illness to reach a physician — they may be poor, homeless, living chaotic lives, or thwarted by the illness itself — and that the best place for them to get physical care is where they already receive psychiatric care. Her council helps organizations coordinate care; integration often starts by placing primary care and mental health providers in the same office, she said, but to have real impact they must also plan and deliver care together.

Richard Franco, a nurse at Tarzana Treatment Centers who helps direct that collaboration, said physical and mental health issues are closely linked for many patients. A significant correlation exists, for instance, between chronic illness and serious depression: according to the Centers for Disease Control and Prevention, major depressive disorder is found in 40% of cancer patients, 27% of diabetes patients, and 17% of people with heart disease.

Lisa Wong, a district chief with the Los Angeles County Department of Mental Health, said the partnership is helping clients with untreated chronic diseases such as diabetes and high blood pressure begin getting care — a way to “close the loop,” she said — and she hoped to see it expand to other county mental health facilities.

Eileen Bachemin, 50, who lives with depression, said she occasionally has breakdowns that leave her disoriented, unsteady, and exhausted for weeks or months at a time. For years she had no insurance and used the emergency room whenever she needed a doctor, enduring chaotic lobbies and long waits. When her psychiatrist told her she could get medical care in the same office where she saw him, she eagerly agreed, and found it far more relaxing.

Tracy Young saw a physician assistant, Brian Schlesinger, for the first time this month. She already takes two buses to reach the San Fernando center for her psychiatric appointments and was relieved not to have to travel elsewhere for medical attention. During the exam, Schlesinger checked her breathing and asked about her symptoms; she told him she had trouble sleeping, had smoked for 35 years, and that her legs swelled and hurt when she walked. She had come, she explained, because she hadn’t had a medical test in three years.

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Many of your most challenging claims and cases likely present a behavioral health component. BHM offers a reviewer network with the most sub-specialties. Six of the top 10 largest health plans entrust BHM for behavioral health peer reviews. Click here to learn more.

Blue Shield of California Foundation helps fund KHN coverage in California. Originally posted by Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.