Growing Evidence Favors Integrating Behavioral Care with Other Healthcare

Andrew Kitchenman | March 19, 2015 | Health Care
Academic research and local practices point to value of combined approach, but funding remains in question

Dr. Kemi Alli, chief medical officer at Henry J. Austin Health Center, Trenton.
Having a physical illness like congestive heart failure, as well as a mental illness such as depression, has traditionally meant separate trips to a primary-care office and to a behavioral health counselor.

But the experience of medical practices like the Henry J. Austin Health Center in Trenton and academic studies by researchers at Rutgers University are pointing to the potential benefits – both in improving patients’ health and containing costs – of integrating both kinds of care.

At Henry J. Austin, members of a team of providers each focus on a different aspect of a patient’s care. One program at the center, known as Project ACCESS, provides integrated care to patients with HIV/AIDS through the federal Ryan White Program. The teams include a primary-care provider, a behavioral health consultant, a case manager, specialists, nurses, and others.

“It’s about treating the whole person,” said Dr. Kemi Alli, Henry J. Austin’s chief medical officer.

Alli noted that there are a variety of obstacles to integrating behavioral healthcare (which encompasses both mental illness and addiction) and other healthcare.

For example, some clinics have been denied licenses to provide behavioral health services because they don’t have separate entrances or waiting areas for behavioral health and medical patients. She suggested that there’s a disconnect between patient needs and state regulations.

“Which is very interesting, because you can never separate the mental health and primary care illnesses of an individual,” Alli said. “So you say go to this waiting room when you have diabetes and go to this waiting room when you have depression? It just doesn’t work that way.”

A bill, S-2375/A-3700, proposed in the Legislature would eliminate this issue by letting qualified health centers get a single license to provide both medical and behavioral healthcare.

Alli noted, too, that some primary-care providers are being denied reimbursement through Medicaid for diagnosing and treating mental illnesses, even though these providers make most mental-illness diagnoses.

She pointed out that her center serves many more patients than could be treated by nearby behavioral health providers: it treats 15,000 patients annually, and an estimated 9,000 to 10,000 of them have behavioral health issues.

“Elevating the skillsets of our primary-care providers so that they can do more and more,” is necessary, Alli said, adding that this could be done with the support of behavioral-health counselors who serve on integrated care-delivery teams.

Another issue is reliable funding for integrating care. The Trenton health center’s efforts have been funded through grants from the Nicholson Foundation, which works to improve the health of underserved residents, and the federal government. Alli said it’s important that such efforts receive sustainable funding from government and insurers.

“If these issues, if these barriers can’t be addressed, there’s a real question in this state as to how we can move forward,” in better integrating healthcare, Alli said.

The potential pool of beneficiaries is large. A Rutgers University study found that a large percentage of patients who make the most visits to hospitals have mental illnesses, addictions, or both.

“There’s a very high association between being a high (hospital) user and having a behavioral health diagnosis,” said Joel Cantor, director of the Rutgers Center for State Health Policy. He noted that the study found that 75 percent of frequent hospital users had a behavioral health condition.

The issue cuts across different demographics, including patients with private insurance.

“This is not just a Medicaid problem or a problem of uninsured patients, Cantor said, adding that while the rates are elevated for these groups, “this is an issue that all payers have to deal with, not just the public payers.”

Cantor said changes in the state’s Medicaid program offer an opportunity to better integrate care. For example, the state could combine medical and behavioral health insurance payments and care management. He noted that expansion of Medicaid, which added 390,000 residents last year due to the Affordable Care Act, would also increase the number of patients who could benefit from integrated care.

Care integration doesn’t happen only in primary-care offices. For patients with severe mental illnesses, primary care can be provided through a behavioral health program, noted Barbara Kang, director of community health for the Nicholson Foundation. But regardless of the setting, integrating care can increase access to services and reduce the stigma involved with behavioral health issues.

“The current approach to treating these individuals in separate healthcare delivery systems negatively impacts health outcomes and costs,” said Kang, noting studies showing that treatment “of the whole person is a better approach.”

These topics were discussed in an NJ Spotlight webinar held yesterday. The webinar will be available on this website by early next week.