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Integrated Behavioral Health: An Introductory Guide for Providers

Confronting the escalating crisis of behavioral health issues in the United States is a pressing concern. In New York City, only 38% of adults suffering from depression received treatment within a year. This gap in care results from limited access and affordability of treatment, fragmented care coordination, and a lack of specialized providers.

Integrating Behavioral Health into existing medical practices presents a promising solution to these challenges. This approach not only helps overcome barriers to care but is also increasingly viable and sustainable, especially with the Centers for Medicare & Medicaid Services (CMS) now offering reimbursements for practices participating in Integrated Behavioral Health Care.

In this guide, we’ll explore Integrated Behavioral Health Care, discussing its challenges, benefits, and practical tips for implementation in your practice. We’ll also examine how ChartSpan can support you in the process.

What is Integrated Behavioral Health?

Integrated Behavioral Health Care (IBHC) is a holistic approach to healthcare that combines the treatment of mental health, substance abuse, and chronic diseases while accounting for other factors like marriage and family dynamics that influence mental well-being. It extends beyond traditional mental health care behaviors and emotions to look at factors that impact overall health and well-being. 

In a medical setting, IBHC is collaborative and team-based, with healthcare professionals from various disciplines working together to provide comprehensive care. This team typically includes primary care providers, mental health specialists (such as psychologists and psychiatrists), social workers, substance abuse counselors, and, in some cases, marriage and family therapists. 

Within an Integrated Behavioral Health program, these medical professionals collaborate closely. For example, a primary care physician may screen a patient for mental health conditions during a routine check-up. If the physician identifies an issue, they can immediately refer the patient to an in-house mental health professional. This seamless integration ensures a unified care plan addresses the patient’s physical and mental health needs.

The integration also extends to treatment planning and follow-up, with regular communication and shared records between team members. This approach ensures that the patient’s care is not fragmented but delivered in a cohesive, comprehensive manner that acknowledges the complex relationship between physical and behavioral health.

The importance of IBHC 

In treating older patients

Integrated Behavioral Health Care is especially critical for older adults. This demographic faces unique challenges, including social isolation, the loss of loved ones, and the psychological impacts of physical health decline, all of which can trigger or exacerbate mental health issues such as depression and anxiety. The nuanced nature of these conditions in older adults necessitates a specialized approach like IBHC.

Mental health issues in older adults are commonly misinterpreted as typical aspects of aging. Symptoms like decreased energy or a lack of interest, often seen in conditions like depression, are sometimes dismissed as inevitable consequences of getting older. However, this oversimplification overlooks the critical need for proper diagnosis and treatment.

It is crucial to distinguish mental health issues from cognitive disorders like dementia. Although there may be an overlap in symptoms, the treatment paths for mental health disorders and cognitive decline are markedly different. Without an accurate diagnosis, patients risk receiving ineffective or even harmful treatments. 

In treating chronic illness

Chronic illnesses, such as heart disease or diabetes, can lead to or exacerbate mental health conditions. Addressing the chronic illness and the accompanying behavioral health condition can lead to more effective management of each. 

The involvement of multiple specialists in an IBHC program is particularly beneficial for patients with chronic conditions. Primary care providers manage the overall health and coordinate care for chronic conditions, while mental health professionals address the psychological impact and mental health challenges that often accompany chronic illness. This collaborative, multidisciplinary approach ensures comprehensive care, where patients’ physical and mental health needs are addressed cohesively.

Behavioral health disorders

Behavioral health disorders encompass many conditions that impact an individual’s mental well-being and behavior. Mental illnesses fall within behavioral health, but behavioral health extends beyond mental health and also includes harmful or destructive behavioral patterns. 

Here are several common behavioral health conditions: 

1. Depression 

Depression in older adults is marked by a persistent sense of sadness and a noticeable disinterest in previously enjoyed activities. Accompanying these emotional symptoms are often physical manifestations such as fatigue and changes in appetite. Major Depressive Disorders are notably prevalent in older adults, affecting up to 15% of this population. Factors like chronic health conditions and social isolation heighten the risk of developing depression in this age group. 

However, the accurate diagnosis of depression in older adults can be challenging. Its symptoms are frequently misattributed to normal aging processes or physical illnesses, leading to underdiagnosis and, consequently, a lack of appropriate treatment.

2. Anxiety

Anxiety disorders include generalized anxiety disorder, panic disorder, and phobias, manifested as excessive and persistent worry. In older adults, these disorders can exacerbate or mimic physical health problems, complicating diagnosis and treatment.

3. Post-Traumatic Stress Disorder (PTSD) 

PTSD arises from experiencing or witnessing traumatic events. Its symptoms include flashbacks, severe anxiety, and uncontrollable thoughts about the event. PTSD can be particularly challenging in older adults as they may have cumulative trauma or may struggle more with the physiological responses to stress.

4. Bipolar Disorder 

Extreme mood swings ranging from depressive lows to manic highs characterize bipolar disorder. Managing bipolar disorder in older adults requires careful consideration, as physiological changes with aging can affect the course of the disorder and responses to treatment.

5. Gambling addiction 

Gambling addiction and other behavioral addictions can be particularly detrimental in older adults. The consequences can be more severe as older patients may have limited means to recover financially and fewer opportunities to rebuild social networks disrupted by their addiction.

6. Substance abuse 

Substance abuse includes the misuse of alcohol, prescription medications, and other drugs. This abuse can be either intentional or accidental, especially in older adults. Intentional misuse often stems from attempts to self-medicate for issues like pain, sleep disturbances, or emotional distress. Accidental misuse, on the other hand, can occur due to factors like confusion over medication instructions or the inability to manage multiple prescriptions effectively.

7. Suicide 

The issue of suicide among older adults is a matter of urgent concern. Adults over 65 account for 17.9% of suicides. This demographic is particularly vulnerable due to a range of risk factors, including the presence of chronic illnesses, experiences of social isolation, and the prevalence of depression. These factors can combine to increase the risk of suicide among older adults significantly. 

Integrated Behavioral Health Care models

The Primary Care Behavioral Health and Collaborative Care models offer comprehensive approaches to integrating behavioral health into primary care settings, each with unique focuses. The PCBH model emphasizes immediate behavioral health support, while CoCM provides a structured, systematic approach to managing chronic conditions with a strong emphasis on quality improvement and coordinated care.

Primary Care Behavioral Health Model (PCBH)

In the PCBH model, the primary care team includes a licensed behavioral health consultant (BHC), like a psychologist or clinical social worker, who offers direct consultations and interventions for behavioral health issues within the primary care setting.

The BHC collaborates with the medical staff to develop and follow up on treatment plans, focusing on integrating behavioral health management — including stress management and lifestyle adjustments — into primary care. This approach ensures swift access to behavioral health services and offers integrated care in a setting that’s familiar to patients.

Collaborative Care Model (CoCM)

CoCM is designed to manage chronic mental and physical health conditions more effectively. CoCM emphasizes quality improvement by systematically tracking patient outcomes, adjusting treatments as necessary, and applying evidence-based care practices. This model includes consistent, proactive patient check-ins in person or via telehealth to evaluate their condition and make timely treatment modifications.

A care manager, often a nurse, social worker, or another healthcare professional, works closely with the patient to manage their treatment plan, facilitate communication between them and the healthcare team, and monitor their progress. Psychiatrists or other specialists provide consultation and recommendations for complex cases to assist the care team. 

Benefits of Integrated Behavioral Health

Extends access to care for patients

Integrating mental health specialists into primary care settings gives patients access to multiple types of care in one location. This makes it easier and more convenient to provide comprehensive treatment. It simplifies their healthcare journey by reducing the need for patients to make separate appointments at multiple locations.

Relieves time for doctors

Primary care doctors can share the responsibility of patient care with experts in specific mental health fields. This collaboration allows primary care physicians to focus more on general health issues while specialists handle the complexities of behavioral health. This eases the workload of primary care doctors and ensures that patients receive specialized attention for their specific needs.

Closes gaps in care 

The traditional separation of physical and mental health services often leads to gaps in care. IBHC bridges these gaps by providing a more coordinated approach. Health professionals from various disciplines work together to create a unified treatment plan to address all aspects of a patient’s health.

Offers reimbursements for providers 

CMS reimbursements for IBHC help offset costs associated with implementing integrated care, such as hiring specialized staff and investing in necessary resources. As a result, your practice can sustainably maintain and expand its integrated services for more effective management of patient’s physical and mental health conditions.

Learn more: Behavioral Health Billing Guidelines for Providers

Promotes positive outcomes and patient satisfaction

The coordinated approach of IBHC often leads to better health outcomes. Patients benefit from a treatment plan that addresses their physical and mental health needs, leading to more effective management of chronic conditions, improved overall health, and enhanced quality of life. Additionally, the convenience and comprehensiveness of IBHC contribute to higher patient satisfaction, as patients feel their diverse health needs are being acknowledged and addressed.

Implementing Behavioral Health in your practice

1. Collaboration

Behavioral Health Care involves forming partnerships with mental health professionals, such as psychologists, psychiatrists, and counselors, who can work alongside your existing medical team. These collaborations can be within the practice or through connections with external behavioral health providers. Effective collaboration ensures a comprehensive approach to patient care, allowing for seamless referrals and joint management of patient treatment plans.

CMS’s new Medicare policy, effective January 1, 2023, expands the range of behavioral health professionals eligible to join primary care teams, including clinical psychologists, social workers, and various licensed therapists and counselors. This policy update allows these practitioners to operate under general supervision instead of the previously mandated direct supervision. 

This change enables the delivery of behavioral health services without needing a supervising physician or practitioner on-site, thereby greatly enhancing the accessibility of these services to Medicare patients.

2. Mental health screenings

Incorporating mental health screenings into routine patient assessments is crucial. Regular screenings help in the early identification of mental health issues, facilitating timely intervention. These screenings can be integrated into standard patient visits using validated tools and questionnaires to assess mental well-being. Training the medical staff to recognize signs of mental health issues and to conduct these screenings effectively is essential for this process.

3. Shared Electronic Health Records (EHRs)

Shared EHRs ensure that all healthcare team members, including behavioral health specialists, have access to patient information. This shared access promotes coordinated care, as all health providers can view treatment plans, notes, and patient progress, allowing for more informed decision-making and continuity of care.

4. Community resources

Leveraging community resources involves connecting patients with local support groups, mental health organizations, and other community-based services. These resources can provide additional support for patients, ranging from therapy groups to educational workshops, and can be an invaluable extension of the care provided within the medical practice.

5. Family support or support from loved ones

Incorporating family and friends’ support into the treatment plan is essential, especially for patients with chronic mental health conditions. Family members or other loved ones can be crucial in the patient’s care and recovery process. Educating loved ones about mental health conditions, involving them in treatment plans, and providing resources for family counseling can enhance the support system for the patient and improve treatment outcomes.

6. Management of chronic mental health conditions

Effective management of chronic mental health conditions requires a long-term, integrated approach. This involves regular monitoring, ongoing therapy, medication refill assistance, and continuous support. Personalizing treatment plans to meet the individual needs of patients and adjusting these plans as required is critical to managing chronic conditions effectively. 

Outsourcing IBHC services to a behavioral health vendor

Outsourcing IBHC services to a vendor can enhance the effectiveness and efficiency of integrating behavioral health into your medical practice. Some vendors can identify patients who qualify for your Behavioral Health Care program, ensuring proactive care management and streamlining your workflow. Vendors are equipped with the necessary tools to administer mental health screenings and often have licensed counselors and therapists on hand, providing direct assistance to patients in need. 

Beyond clinical support, IBHC vendors offer invaluable assistance in connecting patients with a broad network of community resources, broadening their overall support system. They can also assist patients in managing chronic mental health conditions and integrate family support into treatment plans. 

How ChartSpan can help your practice address behavioral health

At ChartSpan, we understand the complexities and challenges of helping patients manage chronic mental health conditions alongside other chronic illnesses. We’re a leading Chronic Care Management company that can support your practice in implementing effective behavioral health care. 

We can seamlessly combine Behavioral Health Care with Chronic Care Management. The ChartSpan team works with providers to coordinate chronic health care, equipping your practice with the necessary tools and support to offer comprehensive care for patients’ chronic mental and physical health needs. With our support, your practice can extend its services to provide a more holistic approach to healthcare.

If you’re a medical provider seeking to implement a Behavioral Health Care program or a Chronic Care Management program, ChartSpan is here to assist you. Reach out to discover how we can help you elevate your practice’s level of care.

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