Expanding Behavioral Health Access with Integrated Care Must Be Health Systems’ ‘True North’

Massive demand for behavioral health care in the primary care setting is forcing an overdue fusion of the two segments of medicine. 

However, whether health care systems or payers are ready, this fusion is happening.

“Primary care functions as a catch-all because we take care of the whole patient. There’s work that falls on us whether or not our systems are prepared to support us in handling it,” Dr. Anna Flattau, chair of family and community medicine and enterprise vice president for Jefferson Primary Care, said during a Tuesday webinar. “When people talk about the integration of mental health and physical health, it’s almost framed as a temporary emergency … It’s never going to change — this is going to be a primary care problem forever.”

Jefferson Primary Care is part of the Philadelphia-based Thomas Jefferson University Hospitals system

Integrating primary and behavioral health care allows providers to improve health and reduce the need for additional health care.

Other panelists referred to a Milliman study that found patients with behavioral health conditions can have annual health care costs that are 2.8 to 6.2 times higher than those that do not, depending on the type and severity of the behavioral health condition. 

“Enhancing access to behavioral healthcare services, I think, is the true north,” Stephen Merz, chief operating officer for Sheppard Pratt Solutions, said during the webinar.

Sheppard Pratt Solutions is a consulting division of the large Baltimore-based nonprofit behavioral health provider Sheppard Pratt.

Merz said that improving access to behavioral health through an integrated care model lowers overall health care spending and improves the health of populations, “bending” the population cost to provide care.

“If there’s one thing to narrow it down to, it’s this: expanding access to behavioral health care is where you should focus and the area of integrated care in primary care is probably the No. 1 area that I’d recommend that people look at,” Merz said.

While the move expands access to the very first and least intensive levels of care, integrated care models reach populations that might otherwise not be engaged with behavioral health providers, said Dr. Lee Tynes, a psychiatry professor at Tulane University School of Medicine.

Tulane University School of Medicine is based in New Orleans.

Tynes recalled several instances in his practice and from colleagues’ descriptions of patients having struggled with mental health issues for decades that would only open up to their primary care providers, highlighting the importance of primary care relationships.

Integrated care, however, doesn’t fix underlying mental health clinician shortage issues, and it indirectly improves access to care for those with serious mental illness (SMI), he added.

“They trust their PCP. If they don’t get treated there, they don’t go anywhere else,” Tynes said. “The need is almost endless, bottomless. So, any access is improved access.”

The speakers also highlighted innovations from the federal government that may open the way for wider use of integrated care models.

The Center for Medicare & Medicaid Innovation Comprehensive Primary Care Plus model (CPC+) led to a large share of pilot participants to co-locate behavioral health services in primary care clinics. However, it required nontraditional services and payer relationships to make the model work.

Federal regulation has loosened to enable telehealth consults for certain facility-based providers and to allow Medicaid plans to reimburse behavioral health specialists for interprofessional consultations.

Investors have poured millions into providers that integrate primary and behavioral health care. Concert Health, which helps primary care providers integrate behavioral health, raised a $42 million Series B funding round in April 2022. In the senior care space, Oak Street Health and Elara Caring integrate behavioral health into their value-based care reimbursement and comprehensive care models.