How Behavioral Health Integration Can Reduce Health Care Costs Mark Rosenburg, MD, PhD
Summary Health care costs are rising in uncontrollable rates. One of the major components of health care expenses is Behavioral Health and the lack of integration between behavioral and medical care. Currently, each sector is treated independently, which is sometimes referred to as the silo effect. This silo effect contributes to the rising health care costs and simultaneously provides a disservice to the patient. Many patients who are treated in a primary care setting additionally have mental health issues. The integration of medical and behavioral health can help reduce costs and provide better quality care. Key Points • Top 5 percent of patients using 50 percent of health care resources • 60 to 80 percent have co-morbid mental conditions • 70 to 85 percent receive no mental health treatment • 80 to 90 percent with a mental health condition see no mental health specialist • 5 to 15 percent get mental health treatment and would be expected to improve outcomes
Barriers to Integration
There are many barriers that have precluded true integration between medical and behavioral health. In general, primary care physicians lack the training to properly diagnose and treat mental illness conditions. A complementary component of this barrier is the lack of physicians. Nationwide, there is a shortage of both primary care physicians and psychiatrists; conversely, there is a rising demand for mental health services, causing a gap in health care treatment. For those areas in which physician shortages are not an issue, payment becomes a primary obstacle. Financial reimbursement for health care is addressed differently for each sector and contributes to a silo effect that maintains separation between behavioral health and other medical services. Logistically, billing is generally completed independently between care providers, and often the distinctions in care, coding, and general practice areas, mean that different systems that may not be compatible are in place. Ensuring that all parties are appropriately reimbursed is an important piece of integration, and there is great opportunity for financial/billing prac-
tice models to be developed to eliminate this barrier to integration. Coding additionally needs to be examined to ensure that there is an integration of coding, or complementary coding, in place and that all parties and practice types are knowledgeable as to how to best utilize this coding to accurately reflect services provided, and receive appropriate compensation. Finally, barriers to care are further expanded when there is a lack of adoption of communication strategies between the two sectors. Care Management and Case Management are offering some improvements to this area, but for most providers the communication gap is still in place. Potential Integration Models The Chronic Care Model
The Chronic Care Model begins with outpatient and strives to identify behavioral health disorders early in the process. The cost savings, with early detection of mental health issues, and depression in particular, are derived from fewer emergency room admissions/readmissions. (Exhibit 2).
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