As behavioral health needs surge across the U.S., healthcare systems are embedding services into primary and emergency care settings to improve access, reduce wait times and connect patients with appropriate mental health support.
Here are six systems and how they are integrating behavioral health:
- UCHealth’s behavioral health integration
In 2019, Aurora, Colo.-based UCHealth made a $150 million investment in behavioral health, aimed to build capacity across its continuum of care — inpatient, outpatient, crisis services, virtual care and primary care integration, according to Elicia Bunch, vice president of behavioral health.
Since the investment, the system has integrated behavioral health services into more than 60 primary care clinics, with a focus on addressing the whole person. A central aim of its integration efforts is reducing barriers to behavioral health services, including stigma.
When primary care providers — who have established relationships with patients — refer them to behavioral health providers within the same clinic, it helps normalize those conversations, Ms. Bunch said.
- Hartford HealthCare’s collaborative care model
Hartford (Conn.) HealthCare has embedded 15 licensed clinical social workers across more than 40 primary care offices, with 12 offices and three care managers supporting the collaborative care model, according to Ashley Shattuck, program manager for integrated care and primary care, Hartford HealthCare Medical Group.
“[The system] focuses on educating not just the primary care providers, but the practice as a whole,” Ms. Shattuck said. “We actually leverage the whole team of the office as just as important in being the eyes and ears and helping the primary care providers identify patients who could benefit from integrated care services.”
An evolving registry of about 150 patients enrolled in the model has seen a 78.29% positive change in PHQ-9 scores and an 82% positive change in GAD-7 scores, with average enrollment ranging from three to six months. In the past six months, 45 patients have graduated from the program, Ms. Shattuck said.
- Mercy’s collaborative care model
Chesterfield, Mo.-based Mercy has spent the past five years scaling a collaborative care management model across roughly 300 clinics in four states with the goal of integrating behavioral health into routine medical care, according to Patty Morrow, vice president of behavioral health services.
Mercy has leveraged relationships with payers and state Medicaid programs for the past four years to improve reimbursement for collaborative care services, Ms. Morrow said.
For example, Missouri Medicaid initially did not recognize collaborative care codes. Mercy worked with government relations, internal payer partnership and other stakeholders to push for code adoption. That successful reimbursement pathway has been key to sustainability, Ms. Morrow said.
Another crucial element has been physician leadership, she added.
“If it’s just a behavioral health division or a psychiatry arm that is going to primary care and saying we need you to adopt this program… without the joint representation of primary care leadership, I think you’re going to fail, quite frankly,” Ms. Morrow said.
- Phoenix Children’s integration in the ED
Following the pandemic, Phoenix Children’s stationed psychiatric nurse practitioners in its emergency departments, allowing assessments and treatment — including medication — for children waiting for psychiatric services. At one time, there were nearly 24 children waiting for services, Funda Bachini, MD, division chief of psychiatry, told Becker’s.
“There are really long wait times in the community to see a psychiatrist, waiting on average six months, which is really hard,” she said. “If you’re at the point where you’ve reached out to a psychiatrist, you need help now, or else you wouldn’t be reaching out.”
The hospital also added mental health therapists so patients with psychiatric and mental health needs are seen within two hours of entering the department.
- Baptist Health’s collaborative care model
With 270 primary care physicians, 61 offices and only 40 providers, about 50 therapists and 31 behavioral health offices, Jacksonville, Fla.-based Baptist Health turned to a collaborative care model. It saw significant gains, including a 30% decrease in behavioral health referrals.
“We have way too many people needing behavioral health services and not enough providers,” said Karen McNeely, DNP, APRN, the system’s APP service line chief and program director of its APP fellowship. “Access was clearly a problem.”
As behavioral health referrals began flooding in, a large volume was for low-acuity patients whose symptoms could be managed by a primary care physician, Ms. McNeely said. This shift opened specialists’ schedules to serve higher-acuity patients with more complex needs.
- Magellan Health’s pediatric collaborative care model
Frisco, Texas-based Magellan Health launched a pediatric collaborative care model that enrolled nearly 8,000 patients, with 84% enrollment after assessment, and more than half stayed engaged through graduation. Forty percent of those graduates achieved clinically significant symptom reduction.
“The most important part about the collaborative care model is that it’s highly evidence-based, and it’s a proven model,” Magellan Health CEO Caroline Carney, MD, said. “It has been proven over and over again in research to increase quality of care, reduce cost of care and promote measurement-informed care.”
The model requires cultural change in clinics, she said. Once it is embedded, primary care providers become more confident asking about depression and suicidality because they are backed by a care manager and a consulting psychiatrist, she said.
