Commentary

Integrating behavioral health and primary care

Publish date: November 21, 2017

This is the fourth in a series of articles from the National Center for Excellence in Primary Care Research (NCEPCR) in the Agency for Healthcare Research and Quality (AHRQ). This series introduces sets of tools and resources designed to help your practice.

Many patients with anxiety, depression, behavioral problems, substance abuse, and other mental and behavioral health conditions turn to their primary care providers as their first, and often only, source of mental health care. Unfortunately, this care may not be as effective as patients and primary care personnel would hope or expect it to be. Problems exist with missed or inaccurate diagnoses, referrals and coordination of care, and other failures in detection and treatment (NIMH Integrated Care Web site, accessed Oct. 1, 2017).

Dr. Janice L. Genevro

There are evidence-based ways to improve this care, however. Behavioral health integration is care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address common primary care issues such as mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illness), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization. The Agency for Healthcare Research and Quality created the Academy for Integrating Behavioral Health and Primary Care to serve as a national resource and a coordinating center for people committed to delivering comprehensive, whole-person health care.

Through the Academy’s web portal interested clinicians, health care administrators, quality improvement specialists, and others can access a wide range of resources related to behavioral health integration. A hallmark of the site is the Integration Playbook, developed as a guide to integrating behavioral health in primary care and other ambulatory care settings. The Playbook assists the growing number of primary care practices and health systems that are beginning to design and implement integrated behavioral health services. The Playbook’s implementation framework is designed to be meaningful at any level of integration development.

Dr. Theodore Ganiats

The Playbook is backed by years of AHRQ work that produced the Academy’s Lexicon for Behavioral Health and Primary Care Integration. The Academy’s Lexicon was created in recognition of the importance of developing shared language that enables communication and collaboration across sites, disciplines, and time. It is a set of concepts and definitions developed by expert consensus to provide a functional definition of behavioral health integration as implemented in actual practice settings. The consensus Lexicon enables effective communication and concerted action among clinicians, care systems, health plans, payers, researchers, policymakers, and patients working for effective, widespread implementation on a meaningful scale.

One challenge in implementing primary care and behavioral health integration is connecting the community engaged in integrated health care. Often behavioral health and primary care providers operate within the same building or organization but are not be aware of each other’s presence. One goal of the Academy is to unite these disparate efforts and direct providers towards one another in an attempt to facilitate collaboration. In the same vein, the Academy aims to offer resources to patients and the community on integration, including the identification of integrated practices they can access.

In addition, in order to measure quality of care in this new approach to health care delivery, the Academy created the Atlas of Integrated Behavioral Health Care Quality Measures. Intended for practices and teams that wish to understand whether they are providing high-quality integrated behavioral health care or are preparing to implement integrated care, the Atlas aims to support the field of integrated behavioral health care measurement by 1) presenting a framework for understanding measurement of integrated care; 2) providing a list of existing measures relevant to integrated behavioral health care; and 3) organizing the measures by the framework and by user goals to facilitate selection of measures.

Links from the NCEPCR site:

Tools and Resources for Research, Quality Improvement, and Practice

https://www.ahrq.gov/ncepcr/research-qi-practice/practice-transformation-qi.html

Academy Web Portal: https://www.integrationacademy.ahrq.gov

The Integration Playbook: https://integrationacademy.ahrq.gov/playbook/about-playbook

Lexicon: https://integrationacademy.ahrq.gov/lexicon

Atlas of Integrated Behavioral Health Care Quality Measures: https://integrationacademy.ahrq.gov/resources/ibhc-measures-atlas

These and other tools can be found at the NCEPCR Web site: https://www.ahrq.gov/ncepcr.

Dr. Genevro is a health scientist at AHRQ. Dr. Ganiats is director, National Center for Excellence in Primary Care Research, AHRQ.

Integrating behavioral health and primary care

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