Care Integration Framework Aims to Help Behavioral Providers Improve Outcomes, Entice Payers

Care integration is often viewed through the lens of physical health care: How can primary and urgent care providers blend behavioral health care services into the medical treatment they provide?

However, addressing patients’ physical health needs during behavioral health treatment can be equally as important. Studies suggest that behavioral health providers can improve patient outcomes by implementing even the simplest general health care practices. 

For example, providers who screened behavioral patients for hypertension and diabetes reported a 42% reduction in emergency department visits, according to research from the Health & Medicine Policy Research Group.

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“Behavioral health providers have many more contacts with their consumers than even primary care doctors have with these patients,” Henry Chung — senior medical director for behavioral health integration strategy of Montefiore Care Management Organization (CMO) — told Behavioral Health Business. “Since they have more contacts, there are more opportunities to address prevention opportunities, like helping people to stop smoking … or [address] weight gain.”

Chung, who leads behavioral health integration initiatives at Montefiore and its affiliated partners, recently co-developed a new report aimed to help behavioral health providers tackle the problem.

The report provides evidence-informed guidelines for doctors and policymakers to improve access to primary care for those with chronic behavioral health conditions. The framework was developed by Columbia University, the University of California at San Francisco, the University of Pennsylvania and the National Council for Behavioral Health, with leadership from Montefiore and funding support from New York Community Trust.

Any behavioral health providers can successfully apply the model, the authors say. However, it’s not a one size fits all framework. Rather, it provides highly customizable guidance for organizations of all shapes and sizes.

The framework is flexible based on an organization’s geographic location, partnership relationships and workforce demographics, among other characteristics. It also can be adapted according to what a behavioral health organization hopes to achieve with integration.

In its simplest form, the framework boils down to three main integration models, Chung explained. The models build upon each other, with each one more intensive than the previous.

The first is most appropriate for behavioral health organizations staffed largely by nonmedical personnel such as social workers. The goal is to get patients in front of medical personnel such as primary care providers.

“The most basic integration model is to aim for really excellent medical navigation, meaning that you assess the patient to see whether or not they’ve had regular, routine primary care visits,” Chung said. “You know whether they have any outstanding health issues. And if they have any of those risk factors, you navigate them aggressively to connect them to primary care.”

The next model combines prevention with care navigation.

On top of directing patients to primary care providers, behavioral health providers using this model can do things like ensure patients are getting regular immunizations and screenings. They can also help patients address smoking and weight gain.

Like the previous model, any behavioral health employees can execute the prevention and care navigation process. They don’t necessarily need medical training. 

“[Clinicians can ask,] ‘Have you had your colonoscopy? You’re in that age range. Let me navigate you and make sure you get these routine screening things done,’” Chung said. “It takes some training, but it certainly doesn’t require anybody with a medical license.”

The third model takes things a step further. It’s most appropriate for behavioral health organizations with nurses or doctors on staff, or for those that have great partnership relationships with primary care providers. 

“In that case, maybe you would then be willing to take some level of responsibility for helping to manage some of the patients who have diabetes … [or] hypertension,” Chung said. “So you’re being intentional about what you can manage and figuring out which of these models might apply.”

After providers master any one of the models, they can articulate the value to payers. The framework lends itself well to value-based payment and bundled payment models, Chung said. 

The hope is that the framework will accelerate policy in that direction, enabling behavioral health organizations to take on a larger role in providing whole-person care. 

But first, it’s up to providers themselves to take advantage of this untapped opportunity, Chung said. 

“Number one, we have a role to play in helping our patients to not die sooner,” he said. “Number two: If you’re a payer industry executive, you are fully aware that patients who have behavioral health disorders drive a disproportionate amount of the medical utilization.”

You can check out the full report here.

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