Estimates suggest 40 percent of primary care patients have behavioral health problems, including mental health and substance abuse disorders, disabling psychological symptoms and psychological stress. Yet despite this prevalence, the integration of behavioral health services into primary care is the exception rather than the rule. In fact, previous research suggests nearly 70 percent of the more serious behavioral conditions in primary care are neither assessed nor treated.
Researchers suggest seven programmatic components they consider necessary to provide sustainable, value-added integrated behavioral health care in patient-centered medical homes. These components are to:
- combine medical and behavioral benefits into one payment pool;
- target complex patients for priority behavioral health care;
- use proactive onsite behavioral "teams;"
- match behavioral professional expertise to the need for treatment escalation inherent in stepped care;
- define, measure, and systematically pursue desired outcomes;
- apply evidence-based behavioral treatments; and
- use cross-disciplinary care managers in assisting the most complicated and vulnerable.
The authors assert that by adopting these seven components, medical homes will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services. Unaddressed or ineffectively addressed behavioral health conditions in the medical home, they warn, predict poor medical and behavioral outcomes and continued high cost of care.
By Roger G. Kathol, MD, et al University of Minnesota, Minneapolis