Integrating Behavioral Health into Primary and Specialty Care

There is significant overlap among adults with behavioral health disorders and those with medical conditions, with more than two-thirds of adults with behavioral health disorders also having medical conditions. The integration of behavioral health into primary and specialty medical care is key to:

• Improving patient outcomes and satisfaction
• Increasing access to behavioral health care
• Reducing costs

Behavioral health integration (BHI) streamlines medical, behavioral and physical health care for patients by embedding behavioral health clinicians in primary and specialty medical care practices. This allows patients to receive a wide range of care related to their physical and behavioral health–all in one setting.

At MaineHealth, the treatment model is based on national integration models and has been adapted to a central structure that works regionally across the MaineHealth system to meet the unique needs of each region. Behavioral health clinicians who are part of this model have four primary roles that add value to patient care and outcomes:

1. Treat patients and families
2. Consult to the medical team and staff
3. Link, refer and bridge to additional services
4. Participate in population health activities

MaineHealth began implementing BHI in primary care practices in 2010, piloting this model at 21 practices in 5 regions between 2010 and 2012. Between 2019 and 2020, approximately 70 practices in 7 regions had integrated behavioral health clinicians. Today, the behavioral health integration program exists in over 73 practices and in 9 regions, including 100% of primary care practices and select women’s health practices, specialty clinics and school health centers.

Studies have shown that integrating behavioral health clinicians into primary and specialty medical care practices:

• Improves overall patient outcomes through greater support and collaboration among staff and care providers
• Increases patients’ adherence to treatment plans for mental health disorders
• Increases cost efficiency, with an estimated projection of $35 billion cost savings in U.S. health care spending through effective medical and behavioral health integration

Tracking Progress:

In 2019 within MaineHealth practices:

• About 13,700 patients were seen by the BHI program and over half of patients seeking outpatient behavioral health care were seen in medical practices
• Over 48,000 sessions took place
• About 1,100 “new” patients were seen by the BHI program each month

References:

• Druss BG and Walker ER. Mental Disorders and Medical Comorbidity. Robert Wood Johnson Foundation, Research Synthesis Report No 21, February 2011. www.policysynthesis.org
• Rost et al, JGIM, 2001; Simon et al, Psychological Medicine 1998; Unutzer et al, JAMA, 2002; Gilbody et al, Arch. IM 2006; Thota et al, Am. Journal of Prev. Med. 2012
• Rost et al, JGIM, 2001; Unutzer et al, JAMA, 2002
• Unutzer et al, JAMA, 2002; Thota et al, Am. Journal of Prev. Med, 2012
• Gilbody et al, British Journal of Psychiatry, 206; Katon et al, Arch Gen. Psych 2002; Katon et al, Diabetes Care, 2008; Unutzer et al, American Journal of Managed Care, 2008; Jacob et al, Am. Journal of Prev. Med. 2012
• Milliman Report: Economic Impact of Integrated Medical-Behavioral Healthcare (2014)