The Medical Group Management Association's most recent MGMA Stat
poll asked healthcare leaders if they have integrated behavioral health providers into their practice within the past two years. Nearly one-third (32%) of respondents responded, yes, they have made this change, while a little more than two-thirds (67%) reported they have not. The remaining 1% were unsure. This poll was conducted on Oct. 23, 2018, with 1,313 applicable responses.
Respondents indicating that their practice has integrated behavioral health providers note this is a part of their population health strategy or that they use it for more pointed needs such as smoking cessation or for diabetes or brain tumor patients. Many others said that they have started to use telemedicine as a means of delivering behavioral health care.
For decades, behavioral health has been on the back burner. Inconsistent recognition and substandard payment for behavioral health services have impeded its progression. In addition, primary care physicians shied away from considering the emotional or behavioral component of physical illness, despite data showing they are closely linked.
Behavioral health also has an impact on chronic disease. Between 15% to 30% of people with diabetes also have depression, resulting in worse outcomes, such as higher body mass index (BMI) and increased risk of other conditions (for example, coronary artery disease, cerebrovascular disease and microvascular complications affecting eyes, kidneys, feet and sexual function.) Moreover, up to 33% of those who suffer a heart attack later experience depression. More than one-quarter of adults in the United States experience some type of behavioral health disorder in a given year, according to the Centers for Disease Control and Prevention (CDC). According to a Modern Healthcare
article, while 29% of adults with a medical condition also have some type of mental health disorder, close to 70% of behavioral health patients have a medical co-morbidity.
The landmark 21st Century Cures Act, enacted in December 2016, includes a package of reforms and grants related to behavioral/mental health treatments. The law also established an HHS assistant secretary position to coordinate with other agencies and help address federal strategy for mental health and substance abuse treatment. With this act there is hope that care will improve for patients with mental health and substance abuse disorders and payment will be recognized.
In 2010, the Milbank Memorial Fund published Evolving Models of Behavioral Health Integration in Primary Care
, which outlines the following barriers that persist to some degree in 2018:
- Behavioral and physical health providers have long operated in separate silos. While co-location and employed behavioral health is more common, the integration of physical and behavioral health remains a challenge.
- Sharing of information rarely occurs.
- Confidentiality laws pertaining to substance abuse (federal and state) and mental health (state) are generally more restrictive than those pertaining to physical health. While HIPAA is often cited as a barrier to sharing information between primary care and mental health practitioners, this is not accurate. Sharing information for the purposes of care coordination is a permitted activity under HIPAA and does not require formal consent. However, many states have restrictive mental health laws that need to be reassessed.
- Payment and parity issues are prevalent.
MGMA data show practices are continuing to add behavioral health providers. This is a 5% increase from a similar MGMA Stat poll
in November 2016, in which 27% of respondents reported having added behavioral health providers.
is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat
are available at: http://www.mgma.com/stat
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Pamela Ballou-Nelson, RN, MSPH, CMPE, PhD
- Collins C, Levis Hewson D, Munger R and Wade T. "Evolving models of behavioral health integration in primary care." Milbank Memorial Fund. Available from: http://bit.ly/2PoOPms
- Johnson S. "Addressing behavioral health to improve all health." Modern Healthcare. Available from: http://bit.ly/2RgwjtD
- Szabo L. "Depression in heart attached survivors is common, often untreated." CNN Health. Available from: https://cnn.it/2RcfEHF