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Behavioral health integration: an essential element of population-based healthcare redesign

  • Practice and Public Health Policies
  • Published:
Translational Behavioral Medicine

ABSTRACT

The fundamental aim of healthcare reform is twofold: to provide health insurance coverage for most of the citizens currently uninsured, thereby granting them access to healthcare; and to redesign the overall healthcare system to provide better care and achieve the triple aim (better health for the population, better healthcare for individuals, and at less cost). The foundation for this improved system will rest on a redesigned (i.e., sufficiently comprehensive and integrated) system of primary care, with which all other providers, services, and sites of care are associated. The Patient-Centered Medical Home (PCMH) and its congeners are the best current examples of the kind of primary care that can achieve the triple aim, if they can become sufficiently comprehensive and can adequately integrate services. This means fully integrating behavioral healthcare into the PCMH, a difficult task under the most favorable circumstances. Creating functioning accountable care organizations is an even more daunting task: this requires new principles of collaborating and financing and the current prototypes have generally failed to incorporate behavioral healthcare sufficient to meet even the basic needs of the target population. This paper will discuss (1) the case for and the difficulties associated with integrating behavioral healthcare into primary care at three levels: the practice, the state, and the nation; and (2) how this looks clinically, operationally, and financially.

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Acknowledgment

We would like to thank Larry Green, MD for his contribution and guidance in creating this paper.

Conflicts of interest

The authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Family Medicine, University of Colorado Denver School of Medicine, Mail Stop F496, Academic Office 1, 12631 East 17th Avenue, Aurora, CO, 80045, USA

    Shandra M Brown Levey PhD, Benjamin F Miller PsyD & Frank Verloin deGruy III MD, MSFM

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  1. Shandra M Brown Levey PhD
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  2. Benjamin F Miller PsyD
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  3. Frank Verloin deGruy III MD, MSFM
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Correspondence to Shandra M Brown Levey PhD.

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Implications

Policy: Without the inclusion of behavioral health in healthcare reform efforts, comprehensive, whole-person care will be unachievable and make it more difficult to achieve the triple aim.

Research: It is challenging to truly research primary care without also examining the impact of behavioral health conditions and in some cases behavioral health providers.

Practice: Better understanding of the relationship of behavioral health conditions on medical conditions can help achieve comprehensive, whole-person care.

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Levey, S.M.B., Miller, B.F. & deGruy, F.V. Behavioral health integration: an essential element of population-based healthcare redesign. Behav. Med. Pract. Policy Res. 2, 364–371 (2012). https://doi.org/10.1007/s13142-012-0152-5

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