Pilot Aims to Help Small Medical Practices Integrate Mental Healthcare
Outline has steps for treating behavioral health issues
As part of its commitment to integrating behavioral care with medical care, Montefiore Health System has launched a pilot project to improve the ability of primary care physicians in small practices to treat anxiety, depression, and other common behavioral health problems.
“We want to develop a roadmap for primary care practices of all types and sizes to teach them how to integrate behavioral health into their medical practices, and to evaluate their progress,” says Henry Chung, MD, vice president and chief medical officer at Montefiore’s Care Management Organization, and associate professor of clinical psychiatry at Albert Einstein College of Medicine in New York.
Chung estimates that one in five New Yorkers experiences mental distress, which often affects their physical health. But, because of the stigma of mental health issues and limited behavioral health services, most do not receive adequate care. Chung estimates that 1,000 to 2,000 patients being treated by the practices in the pilot will benefit from integrated services.
“In a perfect world, the primary care provider could talk to patients about their behavioral health diagnosis and how they could manage it in the office. This helps eliminate the stigma that surrounds mental health issues and is more effective than referring patients to a specialist,” Chung says.
Providers have known for a long time that behavioral health problems affect patients’ recovery from physical illness and interfere with their adherence to a treatment plan, Chung points out. When healthcare is fragmented, people fall through the cracks and don’t get the help they need, he adds.
“We are in a time of major changes in our healthcare system as it shifts toward basing payment on quality and outcomes. This gives primary care physicians incentives to incorporate care for behavioral problems into medical practices,” Chung says.
Integrating behavioral health into primary care is easier in large practices that may be able to afford to hire behavioral health practitioners and have administrative support to make follow-up calls, Chung says.
It’s more challenging for primary care physicians in small practices to integrate medical and behavioral healthcare because of limited staff and resources, and the complexity of treatment for patients with behavioral health issues, Chung says.
“With this project, we hope to develop a series of steps that providers can take to provide care for their patients’ behavioral issues along with their medical conditions. We hope to be able to define behavioral health elements that the small practices can handle,” Chung says.
Chung and his team have developed a guide, titled “Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework.” With grants from the United Hospital Fund and the New York State Health Foundation, the team is working with 11 small medical practices to increase their capability of treating behavioral disorders based on their practice structure and the resources available.
The framework divides the components of integration into eight broad domains, including case finding, screening, and referral to care, use of a multidisciplinary professional team, ongoing care management, systematic quality improvement, decision support for measured, stepped care, culturally adapted self-management support, information tracking and exchange among providers, and linkages with community and social services. It includes a series of incremental steps for each domain.
The goal of the pilot program is to define the practices in each domain that small primary care clinics can adapt, Chung says.
Chung and his team will act as advisors to the practices, lead monthly webinars on improving behavioral health knowledge, and work with each practice to develop specific goals based on their patient population. The practices will report on their progress and share successes and barriers to integration.
One area of concern is that the majority of prescriptions for psychotropic drugs are written by primary care physicians with no support from behavioral health clinicians, Chung points out.
Primary care physicians tend to start patients on one psychotropic medication and stick with it, rather than changing medications or doses when patients complain about side effects or don’t seem to be improving, Chung says.
“We want to provide evidence-based training around medications so the primary care physicians will feel as comfortable switching psychotropic medications or increasing doses as they do when they prescribe antibiotics,” Chung says.
The pilot is structured so that practices may choose the components they want to adapt, based on their individual needs, Chung says.
“Some practices may include only a nurse, an office manager, and the physician, but that’s important. It doesn’t matter who is on the team or how big the team is — it’s what the team chooses to do for these patients in an organized way,” Chung says.
As part of its commitment to integrating behavioral care with medical care, Montefiore Health System has launched a pilot project to improve the ability of primary care physicians in small practices to treat anxiety, depression, and other common behavioral health problems.
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