Integrated Care – Coming of Age After 300 Years... Part II of II

The first blog in this two-blog series outlined the circuitous historical route that the mind body connection in medicine has traveled over the ages. A recent original research article and editorial in the Annals of Internal Medicine addresses the factors influencing physician practices adoption of behavioral health integration in the United States. The authors report the results of a qualitative study in which they interviewed the leaders and clinicians of 30 physician practices who had already implemented behavioral health integration.  

There are several approaches to integrating behavioral health into a practice. The first is a co- located model in which the behavioral health practitioners and the practice providers share a common physical space, allowing patients to be treated by both disciplines seamlessly. This model also fosters collaboration, relationships and interaction among the patient’s different providers as they share the same office space and interact with one another on a daily basis.  

The second model is the collaborative model whereby offsite behavioral health clinicians collaborate with providers to create common care plans or joint interventions. In some cases, psychiatrists might be offsite, but offering collaborative support to a team of behavioral health care managers onsite who are interacting directly with the patient. A recent study found that only 44% of primary care providers co-located with behavioral health clinicians. In rural practices the number of co-located practices was even lower at only 26%.  

The Annals study found that practices that had undertaken integration with behavioral health were motivated by a desire to improve access to behavioral health services for patients as well as improve responsiveness to patient’s needs identified in the behavioral health screenings which all practices are now required to conduct. There was also a perception among practices that having this type of practice model enhanced the reputation of the practice.  

The Annals study identified several clear barriers to implementing this model, among them cultural differences between behavioral and non-behavioral health clinicians, impediments to information flow related to non-integrated disparate electronic platforms and onerous, overly restrictive privacy regulations. Billing challenges and payment model deficiencies and concerns regarding financial sustainability were also highlighted as challenges to successful integration.  

Interestingly, the authors refer to the potential for telehealth and virtual care to resolve some of these challenges. The study was clearly conducted prior to the COVID-19 pandemic, which induced a rapid exponential growth of virtual care across both primary care and behavioral health. This trend might blur the differences between the co-located and collaborative models as in the context of virtual care the geographic proximity of the providers matter a lot less.

In the editorial devoted to this topic in the Annals, the author bemoans the fact that less than half of primary care practices have adopted this integrated care model, stating that medicine’s mind body problem persists to this day. There is clear evidence that integrated care models improve patient outcomes. Virtualizing this care will likely further offer ability to scale and implement this model across more practices in both urban and rural settings. Ironically, it might be integrated technology platforms providing automation, effortless interoperability, and analytics-driven medical and behavioral health workflows which will finally help bridge medicine’s mind body divide.  

For more information on this topic, listen to the NextGen® Advisors recent podcast – “Reflections on Behavioral Health Integration”.