It’s becoming rare to find a primary physician that works alone. More and more, we’re seeing integrated co-located networks of medical professionals that incorporate personal physicians, specialists and nurses — a team dedicated to all the needs of the patient in one place.
This idea seems like common sense today, but it was revolutionary when it was first proposed in the 1960s by concerned professionals in the pediatric field. The concept — known as the patient-centered medical home (PCMH) — is known for its commitment to “whole person orientation.” The PCMH model is growing rapidly in acceptance and implementation.
There’s a growing understanding today that behavioral health needs to be incorporated into the PCMH.
“A prime reason for integrating behavioral health into patient-centered medical homes is that behavioral health problems are very common in medical patients and frequently complicate care delivery and effectiveness,” writes Nadine J. Kaslow, a co-author of a study about the role of psychology in PCMH. “Up to 30 percent of primary care patients meet diagnostic criteria for behavioral health problems, including anxiety, mood and substance use disorders. The costs of managing chronic disease increase markedly when co-occurring behavioral health conditions exist.”
Here are five benefits of integrating behavioral health into PCMHs:
Better Behavioral Health Outcomes
A recent University of Washington study tracked nearly 2,000 patients over two years. The results show that patients receiving a collaborative model of care — which the researchers called IMPACT, an acronym for Improving Mood-Promoting Access to Collaborative Treatment — reported a 50 percent decrease in depression symptoms. Those receiving traditional care only saw a 19 percent decrease.
The IMPACT model embeds mental health treatment into primary care and other medical settings. This model is very similar to what experts want to achieve by integrating behavioral health into PCMH.
Better Physical Health Outcomes
Experts have known for years about the role behavioral health plays in overall health. Depression, for example, has been linked to increased risk of death from heart disease and cancer. Drug addiction can make people susceptible to lung disease, cardiovascular disease, stroke, cancer, HIV/AIDS and hepatitis. People with severe mental illnesses, like schizophrenia, typically die 25 years earlier than those without.
Making behavioral health part of physical health treatment can address these health issues, and more.
The American Psychological Association says that mental disorders cost a combined $57.5 billion in the United States. The Substance Abuse and Mental Health Services Administration finds that patients with both a chronic illness and depression incur healthcare costs two to five times higher than those with only a chronic illness.
The PCMH provides opportunities to lower costs, especially administrative costs, for both physical and behavioral health treatment by providing operational efficiencies. A report in Harvard Business Review finds that 14 percent of healthcare spending can be attributed to clinical waste, or costs that can be reduced through better preventative care or higher quality care. Another 9 percent of spending goes to administrative complexity.
Potential for Increased Recognition of Behavioral Health Issues
Because of their close relationship with patients, primary care physicians are in an ideal position to help diagnose behavioral health issues and recommend treatment. But, unless behavioral health is truly integrated into the PCMH model, this opportunity might be lost.
The Agency for Healthcare Research and Quality reports that 20 to 25 percent of the patients in mixed-income areas have mood and anxiety disorders. That figure increases to nearly 50 percent in lower-income areas. However, the report says: “When they do identify these conditions, [primary physicians] more often than not deliver treatment that is suboptimal and characterized by inadequate follow-up and monitoring of patients … When viewed from this perspective, the PCMH will not achieve its goals unless and until it embraces and addresses patients’ mental health needs.”
Improved Care for Children
The Centers for Disease Control and Prevention says millions of children ages 3 to 17 have mental and behavioral issues such as depression, anxiety, ADHD, autism spectrum disorders. A recent study published in the journal Pediatrics finds that a collaborative approach to pediatric health reduces the severity of many behavioral problems. It also had positive effects on parents by reducing distress and parent-child dysfunction.
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