Clinicians and healthcare policymakers are accepting that physical and mental health are closely interconnected. This view is now influencing the aims and focus of value-based care through Chronic Care Management, care coordination, and Integrated Behavioral Health.
Up to 75% of primary care visits include mental or behavioral health issues or conditions. And value-based care has grown to represent more than 40% of alternative payment models in use.
Integrated Behavioral Health seems likely to receive opportunities for broader adoption.
What is Integrated Behavioral Health?
Addressing patients’ mental health conditions has been shown to positively impact the total cost of care and improve an individual’s physical and mental health.
Also known as Behavioral Health Integration, this approach combines mental health treatment with primary care, encompassing mental health, substance use disorders, and stress-related physical symptoms.
Medicare covers a BHI care management program for Part-B beneficiaries (see sections below).
Providing integrated services for behavioral health as telehealth—with or without Chronic Care Management—can support value-based care (VBC) in several ways.
Improve both mental and physical health outcomes
According to the American Hospital Association (AHA), “integrated behavioral health services can improve value not only for the patients but for families, caregivers, health care providers, and the overall health care system.”
The AHA points to improved outcomes when physical and mental health are treated together in an integrated care model.
One study showed that patients with depression and anxiety experienced significantly better results under a collaborative care model than those receiving standard primary care.
For example, Intermountain Healthcare’s team-based BHI-primary care model realized a 46% increase in screening and treatment for depression. The program achieved:
- A 25% improved adherence to diabetes care protocols
- Reduced emergency room visits by 18%
- Reduced hospital admissions by 9.5%
Additionally, BHI has been shown to improve depression scores and patient and physician experiences.
Lower utilization and overall care costs
Integrated behavioral health provides three cost-cutting benefits, including decreased utilization, such as lower emergency department and admission rates.
It’s estimated that integrated behavioral health in the US can create $38-68 billion in healthcare savings annually. One example is the Cherokee Health System, which reduced emergency visits by 68%, hospital care utilization by 37%, and overall care costs by 22%.
It did so by co-locating behavioral health professionals in primary care settings to provide consultations, screen for behavioral health conditions, and track high-need patients.
Enhance treatment plan and medication adherence
By providing behavioral health support, clinicians can strengthen the doctor-patient relationship, build greater trust, and tap into the relationship between physical and mental health.
When addressed holistically, patients are encouraged to stick to their treatment plan. They are supported or educated about why their medication or treatment is necessary and what will help them achieve their goals.
Improve diagnosis of physical symptoms with behavioral causes
Diagnoses and treatment can be elusive when the underlying issue is behavioral.
By assessing mental health, physicians can detect and treat physical symptoms when they have an underlying mental health cause.
Enhance patient experience and satisfaction scores
Integrating physical and behavioral health services facilitates a more seamless care model.
Utilizing BHI as a care management service can enhance overall patient access, timely care, and ongoing help to address physical-mental issues.
These aspects of care have a profound effect on patient satisfaction and can impact quality performance measures that lead to enhanced payments.
Reduce stigma
A RAND report found that “incorporating mental health into primary care removes cultural barriers and stigma.”
Discussing behavioral health issues with a primary care clinician or related clinical professional normalizes it as part of overall health. Under the primary care umbrella, behavioral health can help patients seek care sooner and prevent additional risks.
Senior adult populations at higher risk
Specific senior adult populations are at higher risk for behavioral health conditions and need heightened awareness and increased assessment. These individuals experience increased stress, medical conditions, or comorbidities that make them particularly susceptible.
Considering the following subgroups of patients, as well as any social determinants of health that add to their stress or vulnerability, can support early diagnosis and prompt treatment:
- Veterans
- Isolated seniors or those who live alone
- Caregivers of a spouse, adult child, or grandchild
- Widows, widowers, and those who have lost adult children
- Living with physical, sensory, or cognitive disabilities
- Diagnosed with serious mental illness (SMI)
Individuals with complicated life scenarios like these may require temporary or ongoing assessment, follow-up, and specialty care to avoid worsening conditions or exacerbating existing physical ailments.
Which Integrated Behavioral Health model is best?
A suitable model depends on an organization's resources, patient cohort, community relationships, and value-based care arrangements.
Create your own BHI program using ancillary staff: However, healthcare organizations can follow many of the same practices in implementing a CCM program to create a BHI program.
Add Behavioral Health Integration to an existing CCM program: Practices with a current Chronic Care Management program have a leg up when integrating behavioral health into primary care. Those practices have the standards, operational workflows, and technologies in place to handle regular and remote care management needed for BHI.
Embed psychiatric services staff or use a behavioral health consultant: According to Humana, value-based practices are increasingly hiring or partnering with behavioral health specialists and embedding them in their primary care centers.
The American Medical Association (AMA) highlights successful BHI pilots, including one in Cambridge, Massachusetts, that hired health coaches and trained them for behavioral health care management, including motivational interviewing. Intermountain Health created a BHI program with an advanced practice registered nurse and a couple of pediatricians, providing earlier detection of behavioral symptoms that could impact physical health and vice versa.
Blue Cross North Carolina integrated behavioral health with their accountable care organization (ACO), utilizing a behavioral health consultant (BHC) — a psychologist, licensed clinical social worker, or other behavioral health professional — as a health care team member. They work in a team-based model with other clinicians in the ACO’s network.
Partner or outsource to deliver BHI: Primary care organizations, health systems, and hospitals may outsource their behavioral health integration program. Or they can partner with aligned healthcare organizations to provide integrated care in a value-based care model.
For example, the Greater Baltimore Medical Center and Sheppard Pratt Health System partnered to integrate behavioral health services into a collaborative patient-centered medical home (PCMH) model. Sheppard Pratt embeds full-time behavioral health consultants – including a substance abuse counselor and psychiatrist – with GBMC’s primary care practices. The program has seen improved care and cost outcomes, including:
- 59% decrease in anxiety scores
- 32% drop in depression scores
- Cost of care was reduced by $775,574 over six months and lowered by another $222,000 over 12 months.
Starting a Behavioral Health Integration program
Integrating behavioral health and primary care can help make value-based models more effective. A BHI program utilizes the best-proven care management systems, tools, and approaches.
Medicare created its Behavioral Health Integration care management program to ease access burdens, meet patients at their comfort level, and reach a population generally attributed to be reticent about seeking mental health services.
Providers can use the program to engage patients on a monthly basis between regular appointments. Delivered through remote interactions, either by phone or a telehealth platform, BHI services can include:
- A systematic assessment
- Continuous patient monitoring
- Care plan creation and revision
- Facilitation and coordination of behavioral health treatment
- A continuous relationship with a designated care team member
Eligible BHI conditions include any mental, behavioral health, or psychiatric condition being treated by the billing practitioner, including substance use disorders that are deemed in the clinical judgment of the billing practitioner to warrant BHI services.
The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time. Your patient must present at least one behavioral health condition to be eligible for the program.
Individual care plans are created for, and in collaboration with, the patient upon BHI enrollment. These care plans act as a comprehensive guide to the patient’s goals and health history.
Medicare Part B will cover up to 80% of the program’s cost. Other insurances, such as Medicaid or private companies, may also cover this.
Who can provide BHI?
BHI billing must be directed by a provider with an NPI number. However, clinical staff can administer most of the program, saving physician time and involvement. Eligible providers include:
- Physicians
- Physician assistants
- Nurse practitioners
- Certified nurse midwives
- Clinical nurse specialists
Medicare reimburses for Behavioral Health Integration
Providers are reimbursed for offering BHI program services by using CPT code 99484.
Reimbursement is based on the time spent with each patient per month, needing to meet a 20-minute minimum.
ThoroughCare simplifies Integrated Behavioral Health
ThoroughCare supports end-to-end workflow for this care approach.
Our software platform helps providers streamline patient enrollment and engagement, develop comprehensive, personalized care plans, and track and report billable services. ThoroughCare also:
- Supports staff workflow with guided assessments
- Helps motivate patients through clinical recommendations
- Analyzes patient risk factors and generates clinical recommendations
- Tracks and logs BHI services for an audit-proof record of care
- Supports validated assessments to identify behavioral health conditions, including PHQ-9 (Depression), GAD-7 (Anxiety), CAGE (Alcohol), DAST-10 (Substance Abuse), and MDQ (Mood Disorders).
