Congress Must Invest and Support Evidence-Based Integrated Behavioral Health Care Models

The number of people who suffer from mental health and substance use disorders (SUDs) is reaching crisis levels, and experts are calling on Congress to support diverse payment models that integrate traditional health care with behavioral health.

Investing in evidence-based integrated primary and behavioral health care across multiple models would help, according to Mitch Prinstein – who is the chief science officer of the American Psychological Association.

For individuals with behavioral health issues, up to 75% will seek out assistance through their primary care provider. However, 55% of adults with mental health concerns reportedly go untreated, which has been attributed to the lack of sufficient behavioral health offerings that are integrated into primary care services.

During a recent U.S. Senate hearing, Prinstein – as well as other speakers and lawmakers – touched upon the crisis nationwide of worsening mental health and SUDs, along with discussing policy options that could help reverse the grim trends.

“Integrated care is in fact an excellent way to go,” Prinstein said early on in the hearing. “[But] it’s very hard for people to find a health care provider and a mental health care provider.”

Prinstein – who is also a professor of psychology and neuroscience at the University of North Carolina at Chapel Hill – believes stigma plays a significant role when it comes to behavioral health, preventing people from accessing proper treatment.

“[D]ue to stigma, sometimes even pursuing [treatment] in-person is difficult,” Prinstein said. “But walking into your physician’s office is not attached to stigma.”

Strides have been made over time in reducing stigma regarding behavioral health assistance, with stigma surrounding conditions like depression having fallen, according to a study from JAMA Network Open. That same study, however, finds that stigma for other conditions like alcohol use disorder and schizophrenia remains high – all of which are possibly contributing to the reluctance of many to seek behavioral help.

Other problems such as a lack of providers in certain areas have also been linked with not enough individuals receiving help for behavioral concerns. However, a lack of behavioral health support in primary care settings – where many seek help for behavioral issues – remains problematic for the industry.

The dilemma of integrated health care delivery is also potentially compounded given that there has been an overall rise in demand for behavioral health assistance since the onset of the pandemic.

“[I]implementation of integrated care where primary care and behavioral health care providers work as a team remains unfortunately limited,” Sen. Bob Casey of Pennsylvania said during the hearing. “While there are a lot of models that integrate physical and mental health care, many physicians still don’t have the ability to seamlessly connect patients to a mental health provider.”

To get a breakdown of the lack of integrated care, Prinstein – in his opening testimony – cited examples from data provided by the Centers for Medicare and Medicaid Services (CMS). According to CMS, the number of Medicare behavioral integration billing codes that were established in 2017 roughly doubled between 2018 and 2019.

Less than a quarter of providers using the psychiatrist-based collaborative care model billed using the codes. Additionally, more than 70% of providers using a primary care behavioral health model – or a similar level of care – billed using the codes. However, data showed that less than 1% of Medicare beneficiaries actually received integrated care from modeled programs.

Prinstein said that the road to improving integrated care lies with three approaches, with the first one being new billing processes that both behavioral and primary care providers can understand when rendering services.

“This is really about the time and the funding that’s required for cross training,” Prinstein said. “[T]hat way, physicians and mental health care providers can speak … each other’s language.”

Various studies have championed the idea that integrated care services can be instrumental in lowering care costs and improving outcomes. At the same time, a number of companies such as Concert Health, Oak Street Health (NYSE: OSH) and Crossover Health have emerged in recent years to spearhead the drive towards integrated care services.

Regarding the need to be more diverse overall with integrated health care models, Prinstein said providers have to be “incentivized” and given flexibility to implement these new models.

“[A] one-size-fits-all approach is just not going to work with integrated behavioral care,” he added. “We have evidence that all approaches can be very effective, and primary care providers need to be the folks to decide how best to set it up in a way that meets their needs, their patients and their community.”