The business case for building an integrated model of care

The business case for integration is in the cost savings as well as patient and provider satisfaction. 

But making such a change can be hard. According to Corey Campbell, project manager of the Human Service Center, a behavioral healthcare organization in Peoria, Ill., change and the resistance to it is the number one obstacle to integration between traditional healthcare and behavioral health.

During an afternoon breakout session at the Behavioral Healthcare Executive Summit in St. Louis, he shared lessons learned during the process of building and measuring integrated models of care in a Federally Qualified Health Clinic and assisting two large Accountable Care Organization (ACO) providers in developing a behavioral health consultant model on site at their clinics.

“We fell into integrated care out of necessity—stumbled into it for survival—but this approach is here and it’s coming so you better get on the train,” he said, explaining how receiving a health information technology multi-year grant from SAMSHA and working with the Mobile Wellness and Recovery program evolved into the integration of on-site substance use and behavioral health services in rural settings. 

By the numbers
Campbell discussed how the average annual increase in healthcare expenditures for people with underlying behavioral health disorders is 1.8 times higher than individuals with the same chronic health conditions without a behavioral health disorder, while the average annual cost of care of a dual-eligible patient with an underlying behavioral health disorder is $34,945.

"For us it felt like groundhog’s day when the same person would present and have the same conversations every month with no change,” he said. “[In the industry] we’ve been working with people on behavior change forever. Motivational interviewing and Stages of Change—that’s what it’s all about. That’s our capital, and we can use that to get a seat at the table, because that’s what the medical professional needs.”

The problem is, a majority of people (80 percent) are getting behavioral health services from primary care providers (PCPs). Only 20% of care takes place in a specialty behavioral health center, mental health center or addiction treatment facility. For example, 30 percent of risky drinking, substance abuse or illicit drug use presents in a primary care setting, and PCPs may not be properly trained or ready to address this. Additionally, Campbell said, less than 20 percent of PCP referrals to specialty behavioral health providers—and it’s even less from emergency departments at only 5 percent.

“PCPs are seeing them a lot more before they come to our doors, until it gets so bad that they don’t have any other choices [but to come to us],” Campbell said. “Our agency will just sit back and wait, but we can’t afford to wait around for them to come anymore.”

Benefits of integration
Campbell said that not only were there time and stress savings to the physician care team upon initiation of its program, but more people reached out once there was a better presence of behavioral healthcare services in their area. It provided new treatment opportunities and was able to identify more patients locally with behavioral health programs.

The structure of the program avoided potential stigma surrounding referral to mental health treatment, and both the mind and body of the patients were covered in one appointment. The always-coveted triple aim of improving population health and patient experience and reduced cost was achieved.

Pilot data snapshot:

• Total patients seen (Aug 5 to March 31, 2015): 378 patients/ 656 total appointments; 
• 332 scheduled follow-ups/238 people showed 85 percent; 
• Reasons for referral: depression, anxiety, chronic pain, stress, smoking cessation, weight loss, grief and loss, adjustment and anger management issues;
• Target versus referral rate, 83 percent; and 
• 12 non-ED events (typically averaging around $4,254.95 for behavioral health event) had a cost savings of $51,060. 

Campbell recommends the following integration tips:

• Get office staff on board, utilize proper engagement, and most importantly train. 
• Use positive messaging with patients;
• Warm handoffs act as a therapeutic transfer of power and allows patients to avoid stigma; 
• Ask permission of the patient to give information or an opinion if you're unsure how to handle a situation;
• Rather than telling a patient they need to do something, ask them why they want to make the change; and 
• Give patients choices.

“We have power in this field—our skill and our abilities—of which the medical field needs right now,” he concluded. “Don’t stand still. It's time to become aggressive.”