Ask the Experts: How does integrating behavioral health with primary care make a difference?

Client: Security Health Plan (HRPlaybook)
Original article

It has been a long time coming, but the hearts and minds of the medical community are opening to the idea of considering and treating mental and physical health simultaneously.

An integrated care model, involving coordination of general and behavioral health care, is gaining ground. Having an interconnected approach can provide advantages to the provider and patient on multiple levels. Employers also stand to benefit from this approach as it takes into account both mind and body, increasing the likelihood of improving employee health and wellness.

In fact, one study on the impact of psychological intervention on medical costs found a 16 percent decrease in the use of health care services for those who received behavioral health treatment while that number increase by 12 percent for those who failed to receive such treatment.

Physical and mental health are intrinsically connected. Statistics show one in four primary care patients has depression or some other mental health concern.

Traditionally, you would expect to visit a primary care provider about a potential mental health issue and receive a recommendation or referral to see a professional for counseling or psychiatric help.

What remains unchanged is how the primary care provider is the first point of contact for mental and behavioral health concerns. What’s changing is the way treatment occurs when behavioral health support through a mental health professional is available in a primary care setting.

One of the problems with the traditional model of “see and refer,” is that many patients get lost in the transition. Research shows only around one-third of patients take the next step to see a mental health professional. Most never make an appointment, or they encounter some other barrier to receiving care. Ultimately, these people continue to struggle and are not treated.

Dr. Alpa Shah

Since primary care providers are on the front lines of identifying issues, initiating treatment and coordinating care, they can help patients in a setting where physical and psychiatric care are integrated.

For example, when a physician and psychiatrist work together, it helps to close the loop, improving communications between experts and making better connections between a patient’s physical and mental health.

Including behavioral health services within a primary care facility can also provide physicians with increased confidence when initiating treatment. If they know there is someone in the office who will provide expert advice on mental health issues, they’ll feel more comfortable in their recommendations.

Another hurdle that integrated care helps patients overcome is access to high quality mental health professionals. The healthcare industry is experiencing a shortage of psychiatrists, and it gets worse in certain regions. It may be fairly easy to find a good psychiatrist in Milwaukee or Chicago, but accessing the same kind of help in rural Wisconsin is more of a challenge.

Employing mental health professionals in a centralized healthcare setting, as we do at Marshfield Clinic, allows a greater number of patients to acquire the psychiatric care they need. Furthermore, the integrated care approach allows our clinic to improve access to outside practices and specialists within the community. Those professionals can continue to take in referrals and treat more complex problems while the relatively simple issues can be managed in primary care.

How can employers help improve awareness?

The most important thing employers and human resources professionals can do is work to eliminate the stigma surrounding behavioral health and promote the concept of mind-body connection within the workplace.

It should be acceptable to address mental health issues in the workplace in the same way you’d discuss physical issues. You must view these areas on the same level because they are connected.

If you look at rates of depression with chronic conditions such as cancer or heart disease, you’ll see they go hand-in-hand. When we fail to address mental health concerns, we’re likely to have limited success in treating other medical illnesses.

Separating mental health from physical health only perpetuates discriminating social stigmas. Human resources departments should be aware that a health event like giving birth can be connected to issues such as postpartum depression. Battling an addiction will come with both psychological and physical challenges. Plus, poor mental health can easily lead to deteriorating physical health.

The medical community has come a long way towards understanding how mental and physical health care can coexist. As leaders in your workplace, you can do the same.

What Security Health Plan does differently

The health insurance industry can also take steps towards removing stigmas around mental and behavioral health. At Security Health Plan, we are doing some things I am particularly proud of.

Many health plans implement what’s known as utilization review. That means the insurance company will investigate a claim by calling a facility to try and substantiate why patients were there, how long they need to be there and whether other medical necessities are justified. These are put in place as checks and balances, but they can also be barriers to proper care because utilization review may limit available services.

Security Health Plan is unique in that it does not conduct utilization reviews for patients admitted for mental health treatment. That is an impressive stance for a health insurance carrier to take.

Security Health Plan and Marshfield Clinic have also been at the forefront of supporting the integrated care approach. Our plans pay per member each month towards the integrated care track at Marshfield Clinic. There you will find registered nurse care coordinators embedded in primary care practices who report to a Marshfield Clinic psychiatrist. This ensures early treatment while improving access to other mental health resources and facilities.

About the expert:

Dr. Alpa Shah is a psychiatrist at Marshfield Clinic and the medical director of behavioral health for Security Health Plan. Dr. Shah specializes in Women’s Mental Health with an emphasis on reproductive and gender-specific factors influencing psychiatric illnesses. She is also director of the Perinatal Mood Disorders Program at Marshfield Clinic.

Learn more about help for behavioral health issues through Security Health Plan’s employer coverage, including member access to free personalized help from a Security Health Plan social worker.

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