NHMH –
NO HEALTH
WITHOUT MENTAL
HEALTH

Changing the U.S. healthcare system to make mental health services available as a routine, normal part of a patient’s medical encounters.

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)).

https://search.ahrq.gov/search?q=Integrated+Behavioral+Health

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.
https://bipartisanpolicy.org/report/behavioral-health-2021/
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(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.
https://nap.nationalacademies.org/catalog/25983/implementing-high-quality-primary-care-rebuilding-the-foundation-of-health

(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.
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(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.
https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model
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Dear Patients, How to Engage in Integrated Care

9 Ways To Receive Better Mental Health Services in Primary Care

#1: Know if you need integrated care.  Integrated care is when your mental and physical conditions are treated together in a coordinated fashion in one place, (e.g. primary care PC).  If you are a patient of any age with both physical and mental or addiction issues, you should be receiving integrated care.  Often older, sicker patients with ongoing conditions like diabetes, asthma, cancer who also have depression, anxiety, chronic pain, or substance use disorders, are candidates for these services.

#2:  PC clinics are finding it difficult to give effective integrated care services since it is a developing area of medicine.  Also, primary care clinics vary widely in their general characteristics such as finances, staffing, clinic workflow, culture, insurance accepted.  Plus they vary in their ability or willingness to provide integrated care services. Many practices, including those with deep resources and experience, find integration challenging.

#3: Things to look for:  If you are a patient with medical and mental health needs, things to look for whether your primary care clinic is offering high-quality integrated care:

  • a)  clinic routinely identifies patients with mild/moderate mental health or substance abuse issues who need help
  • b)  once identified, patient receives an assessment of their conditions and a care plan to treat both conditions
  • c)  care team routinely measure and monitor your symptoms and adjust treatment or medications when needed
  • d)  clinic care-teams made up of medical and mental health professionals are trained specifically in how to deliver effective integrated care
  • e)  clinic has solid relationships with outside medical and mental health professionals with whom they can consult and refer patients if needed
  • f)  clinic has cooperative relationships with community-based entities able to assist patients with social issues, e.g. food, housing, transportation etc

#4:  Play your central role. As patient, you are an essential member of the care-team.  Integrated care services will not be effective unless patients play their central role.  Tell your doctor all your health needs, physical and mental, and social stressor issues.  Be as frank and forthright as possible.  Expect to complete periodic patients surveys and questionnaires since this is how care team collects patient-centered data on results and find out what’s working and not.

#5:  Measurement and team care essential.  Consistently measuring and monitoring your medical and mental health/substance symptoms prevents patients from ‘falling through the cracks’ and not improving or recovering.  The care-team wraps services around you, the patient.  The days of only 1on1 care between medical doctor and patient, are mostly passing. There is now so much to be done in primary care that it takes a team to do it comprehensively, thoroughly and in a coordinated fashion and collect data showing the results and value of this innovation. Effective team care also builds and supports relationships and the trust that underlies good healthcare services and patient engagement.

#6: Practice leadership counts.  Look for signs the leaders of the practice or health systems make a priority of, and take pride in, offering effective integrated care.  Integrated care is challenging because it requires the care team learning new habits, new skills and approaches to care.  Are their clear signs that practice leadership fully embrace this way of providing their patients’ healthcare, such as certificates on display showing care team training in integrated care, patient handouts explaining how integrated services work in their practice.

#7:  How it’s done may vary.  Integration may involve onsite mental health professionals working in clinic alongside your medical doctor and/or may involve an offsite psychiatrist that you may only see once reviewing your record and offering advice and recommendations to your doctor on your mental health care.  Either way, your primary care physician remains the quarterback of all your care.  This is ideal since this is a trusted confidential relationship with knowledge of your entire health history.

#8:  Stay engaged with care team.   Especially as they try to work through all your medical and behavioral health issues over a period of time.  Remember:  behavioral health is a new world for primary care.

#9:  Make a move towards high-performing clinics offering integrated care, if necessary!  If your primary care doctor doesn’t take time to listen, ask questions and show interest in BOTH your physical and mental health issues, consider finding another high-quality primary care practice open to practicing integrative medicine.

To Go Deeper:  For more detail read: “Integrating Mental Health Services in Primary Care From the Patient’s Perspective” at www.nhmh.org.

A CALL TO ALL BEHAVIORAL HEALTH INTEGRATION STAKEHOLDERS:   PUT PATIENTS F-I-R-S-T!

To make behavioral integration into medical settings a reality NHMH calls upon all stakeholders to Put Patients First! and relinquish narrow vested interests tied to the status quo.  Now is a time for innovation and for putting the whole health needs of American citizens, mental and physical, first and work together to get that done.  Now is the time for implementing effective, proven integrated medical-behavioral care that is team-based, measurement-based and value-based.

In this first installment of our new NHMH 2021 Mission Statement we discuss:

* Issue overview
* The human toll (true story from frontlines)
* How siloed behavioral-medical care delivery and payment came to be
* Healthcare system changes required now
* Cost to fix
* NHMH specific legislative and regulatory “Asks”

Mission/Policy Statement

NHMH

Is a nonprofit advocacy organization working at the federal and state policy level to make effective behavioral…

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A RECOGNIZED LEADER

In advocacy for medical-behavioral integrated care which means having both your physical…

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BRINGS VALUE

In improved physical and behavioral health outcomes and lowered total  healthcare costs…

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WE GET RESULTS THAT MATTER TO PATIENTS

2024:

  • CMS’s (Centers for Medicare and Medicaid) Innovation Center (CMMI) announced on January 18, 2024 a new demonstration project, called the Innovations in Behavioral Health (IBH) model, to test the impact of a value-based payment model supporting community mental health facilities in providing integrated medical-behavioral health care to launch in the Fall of 2024 and run for eight years.

    The IBH model would bring together the strength and experience of several HHS agencies (CMS, SAMHSA) to focus on the opportunity to impact patient health outcomes in mproving the quality of medical/physical health services in community mental health centers. It would also focus on HHS partnership with State Medicaid Agencies to improve the quality of care of for patients with mental health and addiction problems. IBH will consist of a care delivery framework, integration infrastructure funding, and value-based payment as part of CMS’ priority to enable primary care practices to move from fee-for-service payment to value-based payment.

    https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model

2023:

  • Federal health agency’s (HHS) top research quality unit (AHRQ) released a draft review of all of the existing evidence-based approaches to the integration of behavioral health care in primary care practices.

    The Agency for Health Research Quality on October 2, 2023 issued a comprehensive strategic look at all current evidence-based approaches to the integration of mental health/substance use care in primary care sites, with discussion on the pros/cons, gaps in evidence, areas for future research.

    Strategies Integrating Behavioral Health and Primary Care

  • Medicare’s Innovation Center announced on June 8, 2023 a new voluntary test project for a primary care alternative payment model called Making Care Primary (MCP).

    Integration of behavioral health services will be an essential part of this whole-person care approach to improve patients’ health outcomes and patient experience in primary care, while also lowering costs and treatment delays. It is also part of a larger strategy by Medicare to integrate patient-centered, accountable care in primary care practices. Increased payments will go to practices as they integrate behavioral health services. This demonstration will begin in early 2024 in eight states (CO, MA, MN, NJ, NM, NY, NC and WA) and run for ten years during which time Medicare will be watching practices progress closely and will make adjustments as needed.

  • Bipartisan legislative bill introduced.

    On April 27, 2023 a bipartisan legislative bill was introduced in the U.S. Senate by Senators Catherine Cortez Masto (D-NV) and John Cornyn (R-TX), entitled the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act (S. 1378) in which Medicare payment to primary care practices for delivery of behavioral integration services will be temporarily increased during years 2025-2027. This bill is just one approach the Congress is actively considering to help U.S. primary care clinics adopt evidence-based models of integrated behavioral health care services thereby expanding Americans’ access to mental health care when they visit their primary care doctor.

2022:

  • First Behavioral Health Integration Federal Training Program for Primary Care Practices Created.

    In December 2022 Congress passed the Consolidated Appropriations Act of 2022 which includes a provision for a new federal training and technical assistance program for primary care physicians on delivering evidenced-based, proven effective approaches to integrating behavioral health services (mental health, substance use) in their primary care practices (CAA, Sec. 1301). This is the first behavioral health integration federal training program for PCPs of its kind. It will greatly increase Americans’ access to mental mental health and addiction care. This grant program allows for primary care practices to receive up to $2 million/yr for five years (2023-2037) to help them deliver integrated care including screenings, assessments, and treatments for mental health and addition conditions. (See Archive section for more detail).

  • Congressional Legislation Introduced.

    In 2022 four legislative bills have been introduced in the U.S. Congress, House and Senate, on behavioral health integration. The bills would train primary care physicians to deliver integrated care; increase payment to primary care practices that offer integration services; make behavioral integration in primary care a core part of Medicare and Medicaid programs; and test innovations in how hospitals might provide integrated medical-behavioral care to inpatients. NHMH has provided inputs and recommendations on these bills to the House Energy & Commerce Committee, the Senate Finance Committee and the Senate Help, Education, Labor & Pensions (HELP) Committee and has worked with individual Congressional offices of both parties in support of these bipartisan bills.

  • Biden Administration Includes Integrated Medical-Behavioral Care in its Mental Health Strategy.

    Integrated care is now included in the Federal Government’s March 2, 2022 White House Mental Health Strategy for the first time. See p. 4, the Connect Americans to Care section, bullet #2. This prioritization of integrated care by the Administration is a meaningful, substantive development. While the funding the White House proposes must be enacted by Congress, the federal health department’s (HHS) testing of new payment models to reimburse primary care doctors for providing integrated care can now go ahead. Another significant building block in widespread implementation of whole person care.

2021:

  • New High-Level Bipartisan Call for Health Policy Change Enabling Behavioral Health Integration.

    On March 30, 2021 the highly respected independent Bipartisan Policy Center issued a detailed report urgently calling for integration of mental health into primary care. The Report led by a BPC Task Force comprised of experts and former Members of Congress from both parties, details specific policy actions that should be taken by Congress and relevant health agencies to make effective, evidence-based mental health services available in primary care across the country. NHMH has been engaged with the BPC since 2014 to advance BHI and believes this Report to be a major breakthrough to place BHI high on the health policy reform agenda.

    Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration | Bipartisan Policy Center

2020:

  • Congress Enacts New Law Effective 2020 Helping States to Enforce Compliance with 2008 Federal Parity Law

    The 2020 federal law provides States with badly needed new funding to allow them to carry out mental health parity enforcement and implementation required by the federal parity law passed in 2008. Parity = Access to mental health care. With that in mind, Congress passed the 2008 federal parity law to require a majority of health insurance plans, including those provided by private employers, to cover treatment for mental health conditions no more restrictively than treatment for physical conditions. Implementation of the 2008 federal law requirement by insurers has been slow. The 2020 law funds States to support their oversight of health plans’ compliance with parity requirements as long as States collect and review comparative analyses from insurers.

    MHLG Letter to Senators Murphy and Cassidy

  • Number of Nurse Practitioners Doubles Playing Key Role in Primary Care

    Between 2010-2017 the number of nurse practitioners (nurses with advanced training) grew by 109%, as compared with growth of RNs of 22% and physicians 9%. NPs play a vital role in team-based care such as the integrated medical-physical care in primary care. The significant growth of this key healthcare worker category reflects the increasing focus on improving primary care advocated by groups such as NHMH. Increased educational programs in nursing schools, part of NHMH’s advocacy focus, allows for graduation of more NPs to join primary care clinical care teams.

    nurse-practitioner-workforce-doubles-amid-primary-care-push

2019:

  • Congress Renews Patient-Centered Research Organization Working to Advance Behavioral Integration into Primary Care

    NHMH was one of a coalition of 200 organizations that successfully advocated for Congress to re-authorize the Patient-Centered Outcomes Research Institute (PCORI). With the signing of HR 1865 into law on December 20, 2019, PCORI was re-authorized by Congress to continue its research trials developing information for patients and providers on which treatment approaches work best for what conditions and for which patients, until September 29, 2029. Currently, NHMH is participating in several ongoing PCORI national and regional research studies, all comparing different approaches to integrating mental health treatment into primary care for their effects on patient outcomes, with the aim to make that information available to patients and their doctors.

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We Need Your Help!

NHMH is a national leader in patient advocacy for the integration of medical and behavioral healthcare services.  Why? Because we have kept this one single focus and mission since our establishment in 2007. We also have deep, decades-long understanding of behavioral health policy and practice, as we grew out of NAMI. NHMH receives no government, corporate, pharma or insurance industry money.  This allows us to be an independent voice for the patient and families, always putting their interests first.

In addition to receiving online donations via Paypal, debit or credit card, or by check, NHMH also accepts stock donations.  Please contact us for details.



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OUR PARTNERS & COLLABORATORS

“If you have doubts about the efficacy of offering collaborative care in the primary care setting, just ask a primary care physician who has been exposed to this efficient consultative support, and ask patients who have seen both their physical and behavioral issues addressed in one place in a coordinated fashion and see what response you get!”

Dr. Mark Williams, Mayo Clinic

Read full interview with Dr. Mark Williams of the Mayo Clinic.

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