Primary care providers (PCPs) are often the first stop for patients when seeking behavioral health services.
Busy PCPs often lack the resources to fully incorporate behavioral health services into their practices. But that could change as Congress and state legislatures advocate for more collaborative models of care.
“Primary care is behavioral health,” Melissa Merrick, executive vice president of primary care services at the Southcentral Foundation, said in a Bipartisan Policy Center webinar last week. She says, “A lot of what comes into primary care is related to behavioral health, not just traditional mental health diagnoses, but things like sleep hygiene and health behavior change.”
The South Central Foundation is a nonprofit health system serving Alaska Native and American Indian populations in Anchorage and the Matanuska-Susitna Borough of Alaska.
Private and public agencies are now focused on ways to foster the integration of primary care and behavioral health through health care worker education, innovative payment programs, workforce expansion, and more.
Education about integration
Healthcare provider education is critical to collaborative care efforts. Still, with the provider shortage in full swing, finding time for meaningful continuing education can be difficult unless you make it a priority.
Dr. Atul Grover, executive director of the AAMC Research and Action Institute, said during the webinar, “We need to build a health care system that strengthens people's skills when they finish their training. We can produce 30,000 doctors.'' We work in a team setting every year, but if the medical system itself is beating that practice, then we don't really have any standing. It doesn't mean you've earned it. ”
The AAMC Research and Action Institute is a think tank of the Association of American Medical Colleges. We focus on bipartisan policy reforms and proposals.
This is where Health Resources and Services Administration (HRSA) grants and other training incentives can make a difference. The movement could expand faster if grants supported the integration of behavioral health professionals into primary care practices, Glover said.
Because many healthcare providers must balance large caseloads and provide in-person training, it is important to have the time and funding to conduct additional instruction.
Dr. Brian Baucom, co-director of the University of Utah Behavioral Health Innovation and Dissemination Center, said, “We need funding to protect that time so that training is recognized as an important part of the job as providing care.” We are investing in it,” he said. .
The University of Utah's Behavioral Health Innovation and Dissemination Center provides clinical services, consultation, and training programs. We also conduct clinical research focused on improving the quality of mental health care.
Although there is a new movement to incorporate integrated behavioral health training programs into medical education, many health care providers must take on the task of educating their employees.
“When we started, there wasn't really anyone trained in integrative behavioral health, including myself, so we had to develop an on-the-ground trading program that interacted with our clinics. ,” Merrick said.
Government initiatives
Some government initiatives, such as the Center for Medicare and Medicaid Services Innovation's (CMMI) Primary Care Model, a 10-year program focused on securing value in primary settings, are It is positioned as something that supports the promotion of
Still, many providers implementing primary health and behavioral health integration are still in the early stages.
“The problem with integrative care is that most people who are doing integrative care are not really doing integrative care,” said Dr. Andy Keller, president and CEO of the Meadows Institute for Mental Health Policy. said. “They're doing things like colocation, but they're doing things that aren't really that effective. What makes applying evidence-based integrated care, such as collaborative care, effective is… It's about care based on measurements, such as registers and strict usage. ”
The Meadows Mental Health Policy Institute is an independent, nonpartisan, nonprofit organization working on mental health policies and programs dedicated to building a more equitable system for the people of Texas.
He noted that the language of the CMMI's primary care model needs to be more specific. However, there are ways to tighten regulations even further.
The Bipartisan Policy Center recently Strengthening integrated care human resources report. The report recommends that behavioral health integrated planning should be imputed for applications in primary care and total cost-oriented models of care.
The Bipartisan Policy Center is a nonprofit organization that ensures that “policymakers collaborate across party lines to create bipartisan solutions.”
“We need to…not just incorporate the concept of integration, but make sure that we include it with enough specificity, enough resources, and enough priority to actually achieve results,” Keller said. said. “This report allows people to increase the rigor of their situation by moving towards a common set of outcomes, rather than just imposing a particular model. I think it shows a fairly wide range of paths to… [such as] registry. ”
Role of non-clinical staff in integration
Despite the focus on adding collaborative care to medical training programs and increasing government efforts, staffing remains a major challenge.
Although clinicians are critical to integration efforts, non-clinical workers can represent an untapped workforce that makes these programs possible. For example, the use of peers may facilitate collaborative care.
“If you include non-master's trained professionals such as peer counselors, there are about 1 million people who provide some form of mental health care, but many of them are less likely to be treated as doctors or doctoral psychologists. The training period is also short,” Glover said. . “So we can also increase our labor supply more quickly.”
In addition to expanding the workforce, co-workers have other benefits as well, often allowing them to be more representative of the communities they serve.
“Some of the benefits are; [peers] The idea is to leverage that lived experience and trust to increase access to customers. Access is trust,” Merrick said. “This is how we build trust with patients and how we begin to address health behavior change. I think non-clinical workers have a big role to play in terms of quality of care. , while also really expanding that workforce and strengthening some of the services where clinical workers have limited ways of working.”
There are many ways to achieve collaborative behavioral health in the future, but it will require a team-based approach that brings together various members of the care community.
“Every system is going to have to adapt the model a little bit to what's appropriate for that system,” Merrick said. “This is a balancing act of maintaining fidelity to the model, but also maintaining what works within the system based on care delivery and workforce.”
