Policy Segment 5: Taking behavioral health pressure off primary care

Who is in this video: Dr. Lawrence “Bopper” Deyton is the senior associate dean for clinical public health and a professor of medicine and of health policy and management at George Washington University School of Medicine, Washington; and Lauren Alfred, policy director at the Kennedy Forum.

Dr. Deyton: We’re in a bit of a transition now in terms of the structure of the health care enterprise, and how the incentives, and the funding, and how we’re organized? If we believe that the “triple aim” will work, that is, that the Affordable Care Act’s priorities – improving quality, decreasing cost, improving patient satisfaction in the system – then aren’t we on the cusp of potentially being able to put the distress diagnoses, finding those out, at the top, or close to the top, of the differential list when anybody comes in for any medical interaction?

At least in the literature that I know about – I’m thinking about chronic diseases – people come in with all kinds of behavioral, and emotional, and mental health distress issues, as well as serious mental illness. I think that we are missing opportunities with every interaction to ask about, to screen, and to have a treatment plan for those behavioral and mental health problems.

Now, aren’t we at the cusp of a reimbursement system that should reward for that and help catalyze our systems to change how they are structured?

Lauren Alfred: Absolutely. I think we’re having this conversation, fundamentally, for two reasons. One, because we recognize that the vast majority of patients are going to get this care in the primary care setting. That’s why we’re talking about mental health in primary care. There’s recognition of that by policy makers to say, “I have to address this problem across the continuum of care, but this is where I can make the biggest impact.” They’re driven by dollars, and so this is Then two, back to the idea of education, and the burden that we would be placing on primary care physicians and on our residents to be learning, there is only so much we can do, I would say, given the evidence of education in mental health for these physicians. It’ll only take them so far, and then at some point we have to talk about collaborative care and where we’re going to bring the specialists into the equation.

I think we get into this policy discussion, certainly with medicine, but also with teachers. It’s “How much more are we going to pile onto educators in terms of the things that they have to do for their students?” They have to be the social worker, the mom, the dad, and they have to be thinking about their mental health and about addiction. There are only so many [14:50] things we can expect our primary care physicians to do.

We need to bring them all up to a certain standard and at that point decide, “What are the payment structures, mechanisms, and teams that are in place that then carry us the rest of the way?” Making sure that there is a fundamental understanding of this difference between disorder and distress is certainly a good place to start.