Former NIAC member, Macaran (Mac) Baird, M.D., M.S., knows firsthand about the importance of a solid collaborative care team. He describes how, after experiencing the benefits of integrated services, providers recognize that they can better treat their patients by working with team members who have other skills and expertise. Furthermore, once patients know their clinic offers integrated services, they understand that by working with a mental health teammate, their primary care clinician can be a better provider. In integrated primary care clinics, patients almost always agree to allow a mental health provider to assist in their treatment.
Systematic screening is essential to identify the full range of patient needs, especially those that are hard to describe, such as mental health issues. Debbie Cohen, Ph.D., who served on the Academy project team, discusses the advantages of standardized mental health screening within integrated primary care. Although patients are now more aware of the importance of regular preventive screenings (e.g., mammograms, colonoscopies), they are often reluctant to discuss depressive or anxiety symptoms due to stigma.
Mental health screenings serve several purposes within integrated practices: (1) identification of patients’ mental health needs, and (2) a routine, consistent, and brief method of measurement and assessment for medical professionals to perform during their busy workday. Regular screening directly contributes to improved treatment referral and, therefore, patient satisfaction and outcomes.
Frank DeGruy, M.D., M.S.F.M., has been a leading advocate of integrating behavioral health into primary care settings. Successfully integrated health care relies on the teamwork of three professionals: primary care clinicians, behavioral health clinicians, and care managers/coordinators. To address both the physical and mental health needs of patients, this team must work with patients to address issues, solve problems, and implement effective solutions to improve health outcomes and satisfaction.
This holistic care approach works best when the care team communicates well, maximizes individuals’ strengths and styles, and negotiates leadership roles over time to best target various elements of a care plan. The AHRQ Academy’s Lexicon explains commonly used words in the integrated field to help improve communication. Also, the Community is a forum in which users can discuss the successes, failures, and challenges of integration.
Patients often present in primary care with a number of problems that are usually not addressed in traditional primary care settings. Parinda Khatri, Ph.D., discusses how the primary care clinics of Cherokee Health Systems integrated behavioral health services. Now, they provide more comprehensive care for their patients, which not only meets all their patients’ health care needs but also improves their quality of life.
With an integrated care team, providers can address both the medical needs of their patients, such as chronic disease management and healthy lifestyle changes, and their behavioral health needs, such as depression and other mental health challenges.
Research continues to guide efforts to integrate behavioral health and primary care. The proper translation of this evidence into everyday clinical practice is critical. Neil Korsen, M.D., M.Sc., discusses lessons learned from his work helping primary care practices implement evidence-based integrated care systems into their clinics. He describes three key components of highly successful integrated practices: (1) a behavioral health provider working within the primary care team, (2) clinicians who balance being productive with being accessible to their patients, and (3) ways to anticipate which patients will need integrated services.
The AHRQ Academy is an important tool for those interested in changing health care. Benjamin Miller, Psy.D., describes the benefits of using this tool to help practices change the way health care is delivered.
Namely, the AHRQ Academy Portal will serve as a resource for primary care practices implementing integration, regardless of their stage, to improve patient satisfaction, outcomes, and health care delivery, and to reduce cost. The Portal includes a comprehensive literature collection and a community forum where practices can share approaches they have found to be most effective. Change begins by bringing the voices of the health care community together. Discussing best practices and current health care policies will advance integrated primary care, and thus health care, in our communities.
Health care policy is the backbone on which we can create and support effective and comprehensive approaches to patient care. Health policy expert and former NIAC member Kavita Patel, M.D., M.S.H.S., explains why now is a perfect time to integrate behavioral health and primary care due to the increased number of patient-centered medical homes, accountable care organizations, and statewide comprehensive care initiatives across the country. These current health care policies promote collaborative care and a comprehensive patient-centered approach that includes the integration of behavioral health and primary care services.
While providers may understand recent changes to the health care system, many are still uncertain of what their role is. Continued research is important to show these providers that they can practice in a collaborative team while maintaining their independence in their specialties.
The success of an integrated primary care practice depends on three critical components: (1) good clinical outcomes, (2) operational consistency and reliability, and (3) financial sustainability. C.J. Peek, Ph.D., details the interdependence of these three components in delivering improved health outcomes within integrated settings.
Successful measurement of these components is essential to evaluate the effectiveness of policies and practices over time. These elements can work together to provide the infrastructure for healthy integrated care practices.
Jürgen Unützer, M.D., M.A., M.P.H., discusses the three key outcomes, also known as the “Triple Aim,” identified from 20 years of research and practice and more than 70 publications in integrated care: (1) improved patient experience, (2) better health outcomes, and (3) lower health care costs.
Measurement-based practice is critical to these key outcomes. In this framework, patients describe their mental health symptoms before or during the primary care visit. Research suggests that current mental health treatments are generally only 50 percent effective for all patients. Measurement-based practice allows professionals to assess the severity of symptoms, the treatment to choose, and the efficacy of the treatment. Implementation of measurement-based practices allows clinicians to rely on a brief, yet effective, tool to guide their and their patients’ treatment decisions, thus effectively meeting the goals of the Triple Aim.