Whole person health: A SIM blog (05/31/2019)

Pushing past the 'ouch factor': Integrating behavioral health in primary care

By Heather Grimshaw


Stories about patients with mental health and substance use disorders, who don’t get the care they need make headlines. The stories pull at our heart strings and sense of justice because mental health, substance use and physical health issues affect most families, yet they’re not treated the same way or in the same place.

There are reasons health care providers don’t ask about mental health or substance use issues during primary care visits and one of them is what Laura Carroll, a patient advocate, calls the ouch factor.

“It’s uncomfortable to talk about and there are a lot of unknowns when it comes to our mental health,” says Carroll, honorary patient representative on the Colorado State Innovation Model (SIM) advisory board, who says care teams need to address “the bod and brain” to ensure good health .

Addressing bod and brain
SIM has helped 328 primary care practice sites and four community mental health centers offer physical and behavioral health (mental health, substance use disorders and healthy behaviors). Colorado picked the integration of physical and behavioral health in primary care settings supported by public and private health plans to help providers succeed with alternative payment models (APMs), the goal for SIM investments from the Center for Medicare and Medicaid Services.

It makes sense when you consider that untreated mental health costs billions of dollars annually and that early intervention can improve health and reduce or avoid unnecessary costs, which is essential for success with APMs.

But delivering whole-person care requires time, energy and money from health care teams and it relies on payment that rewards better health outcomes not just the delivery of services.

There’s also the issue that most care teams aren’t trained to address mental health, don’t know what resources exist for referrals and are uncomfortable asking about issues they can’t help patients solve.

“When I first started screening patients for depression, I was shocked by what we heard here in this sleepy burb,” says one physician, whose practice participates in SIM. “I didn’t know how to handle some of it and was thankful that I could pull in our behavioral health provider. I ran to her a lot in the beginning.”

SIM ends in July but providers say they’ll continue delivering whole-person care and can use their data to prove how it improves health and reduces costs, which helps them negotiate APMs to support it.

SIM focused on the business of health care, the work that happens behind the scenes to ensure patients get the care they need. And while business practices focus more on purse strings, improvements in patient care bring the story full circle.

Take, for example, a man who scored high on a depression screening during a wellness visit at a SIM cohort practice and told his provider that he had been depressed for years but would not have brought it up without being prompted. Several of his close friends had died by suicide in the past few years and wondered if discussion about depression could have prevented this. Read the full story.

And consider a pediatric patient, who lost 30-plus pounds and gained coping skills for his anxiety and depression through access to an integrated care team at a SIM cohort practice. Listen to the podcast

While most providers recognize integrated care as the right way to treat patients, thousands have gained the skills they need to offer it and pay for it through SIM. They sat at the same table with health plan representatives talking about data that shows how integrated care results in better health and lower costs and those conversations will continue.

Get a list of practices that offer whole-person care, talk with your care team about addressing your brain and bod during your next visit and help expand patient access to and awareness of whole-person care.