Grassi Healthcare | Integration of Primary Care and Behavioral Health-What Providers Fear Most <em > by Joseph Tomaino</em >
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Integration of Primary Care and Behavioral Health-What Providers Fear Most  by Joseph Tomaino

The focus on value-based care and the associated initiatives that support it (accountable care, managed care, bundled payments, DSRIP, etc.) has forced providers to address the mind-body connection and its impact on utilization of health care resources.  We have known about the interrelationship of physical and mental health for sometime, however there have been significant barriers to the integration of care between these two aspects of health.  Mental illness has carried with it societal stigmas that continue in lesser, but still present, forms today. Reimbursement for mental health care has been much less generous by third parties and utilization is tightly controlled.  For populations receiving care through government funding, the funding sources have been siloed, and each have unique and non-connecting program and compliance requirements.

Now we are being pressed by healthcare reform to overcome these barriers and make care integration between the physical world of primary care, and the mental health world of behavioral health into a reality.  Managers and leaders of these programs must accomplish this despite the barriers described above and face a number of fears as they work toward program integration.

What challenges lie ahead?:
  1. There are significant cultural differences between how primary care is provided and how behavioral health is provided. The physical layout of treatment rooms, the workflow, and the pace of client interactions are very different between the two, and efforts need to be made to accommodate both in the same clinical setting.
  2. It is difficult to know how to code and bill properly and in a compliant fashion.  It isn’t by accident that primary care and behavioral health have not been integrated in the past.  Reimbursement and regulation have been bifurcated and billing rules are different between the two.
  3. Providing new services in a manner that is financially viable based on new staffing needs, building up case volume, and managing patient flow is critical to survival.  Anytime you start a new service, the need to recruit and onboard the right staff and build volume to make the program economically viable requires a ramp up period and financial investment.
  4. For government reimbursed programs, licensure is a maze of evolving realities and very confusing.  In New York State, for example, licensure and program requirements for Article 28 primary care clinics, for Article 31 mental health clinics, and Article 32 substance abuse programs are very different.  Under the DSRIP program in New York, the State has made considerable efforts to help providers navigate the transition and integration between these— however it is still complicated.
  5. Integration of electronic health records creates special challenges to maintaining confidentiality.   Confidentiality laws and regulations surrounding mental health are rigorous and electronic health record systems, which were selected for a single service line, might not have anticipated the need for capacity for role specific access to specific components of the record.

Despite these challenges, the reward for successful integration of primary care and behavioral health can be significant.  According to a 2013 presentation made by New York State Senior Deputy Commissioner of Mental Health, Robert Myers, 82% of hospital re-admissions for medical reasons have an underlying behavioral health diagnosis.  In a health care reform environment where the focus is on reducing unnecessary re-admissions, the provision of concurrent and effective behavioral health care is critical.  These challenges and fears can be overcome with knowledgeable technical support and mentorship by provider and organization leaders who have successfully navigated the integration.
For more information about the integration of primary care and behavioral health, contact Joseph Tomaino, Chief Executive Officer of Grassi Healthcare Advisors, LLC, at