A New Dawn Rising: The U.S. national health system has begun entering a new era of making effective high-quality, evidence-based behavioral health services widely available for patients in their trusted primary care clinics including mental health and substance use/addiction care. We are also approaching the day when integrated medical and behavioral health care services will be covered benefits in people’s medical health insurance plans.
What is Integrated Behavioral Health (IBH)?
“IBH is the care that results from a practice team of primary care (or family medicine or pediatric services) and behavioral health clinicians (trained healthcare professionals who provide care in a clinic) working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined patient population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of healthcare utilization.” (Source: U.S. Department of Health & Human Services, Agency for Health Research and Quality (AHRQ)).
IMPORTANT PROGRESS UPDATE: 4 MAJOR DEVELOPMENTS IN PAST 3 YEARS ADVANCING BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION
Changing our U.S. national healthcare system to ensure integration of behavioral health and primary care (BHI) requires a complex process of scientific evidence creation, consensus-building, and translation of the evidence consensus into concrete health reform policy changes in form of supportive laws and regulations. NHMH is pleased to report in the past 3 years there have been 4 major developments, in which NHMH with collaborators has participated in or responded to, driving integrated care.
(1) Bipartisan Policy Center Successive policy recommendation reports on behavioral health integration: (A) the December 2023 “Strengthening the Integrated Care Workforce,” report providing federal policy recommendations to support and expand the workforce responsible for delivering integrated behavioral health and primary care services by focusing on ways to train, recruit, pay for, and flex the behavioral health integration workforce; (B) the May 2023 “Achieving Behavioral Health Care Integration in Rural America,” report providing policy recommendations to expand integrated primary care and behavioral health services in rural America by leveraging Rural Health Clinics and Federally Qualified Health Centers in these communities as primary care providers often serve as a gateway into behavioral health care; and (C) the March 2021 Report “Tackling America’s Mental Health & Addiction Crisis through Primary Care Integration,” recommending specific federal policy actions for the integration of behavioral health and primary care to enhance access to whole person care for adults and children, improve health outcomes, reduce disparities and increase cost savings.
(2) National Academies of Science, Engineering & Medicine (NASEM) Report (May 2021) – a blueprint from eminent national scientific body for investment in primary care (where BHI occurs) transformation and modernization resulting in an Action Plan supported by multiple federal health agencies, advocates and members of Congress.
(3) Agency for Health Research & Quality (HHS/AHRQ) Draft Strategic Review (October 2023) – up-to-date and comprehensive review of the entire landscape of the evidence base of all current approaches to behavioral health and primary care integration.
(4) Centers for Medicare & Medicaid Services Innovation Center integration developments: (A) January 2024 announcement of the Innovation in Behavioral Health (IBH) value-based alternative payment voluntary demonstration model to launch in 8 States in the Fall of 2024, targeting improvement of physical health outcomes for patients with moderate/serious behavioral health conditions in community behavioral health facilities; (B) the November 2023 release of a CMMI Retrospective Review “Accelerating Care Delivery Transformation – The CMS Innovation Center’s Role in the Next Decade”; and (C) the June 2023 announcement of the Making Care Primary (MCP) value-based alternative payment demonstration model to launch in 8 States in July 2024 targeting support and incentives to primary care clinicians enabling their partnerships with specialists and community resources to address primary care patients medical and behavioral health needs.