Three reasons why integrating behavioral health services may benefit your primary care practice

More than 70% of primary care visits are related to psychosocial issues, including anxiety and depression. Although few primary care physicians currently have the resources to help patients address those issues, a new program at the Harvard Medical School Center for Primary Care may show that investing in those services is worthwhile both for the provider and the patient. 

As part of the Center’s Academic Innovations Collaborative, six of the 18 medical practices under the center will integrate behavioral health services into their primary care facilities. The initiative is funded through a two-year grant, and the remaining 12 sites can apply next year.

Russ Phillips, MD, director of the Center for Primary Care at Harvard Medical School, says it’s not that primary care physicians don’t want to screen for mental health disorders, but that they aren’t equipped to deal with the findings.

“Screening is only worth doing if you have the resources within your practice to actually treat problems that you detect,” he says. “Traditionally, behavioral health has been sort of marginalized, and patients have been treated separately from those with physical health concerns. But we know mental health issues present commonly in primary care and complicate the care of patients with other medical conditions. So trying to integrate those services into primary care practices makes sense.”

The program creates a network of staff within the practice to actively connect with patients and to evaluate their status. It will also provide practices with social workers who can counsel patients, and mental health specialists who physicians can consult if their patients don’t respond to initial treatment.

Phillips says primary care practices may benefit from offering behavioral health services in three different ways:

• Improved patient health – By addressing mental health issues with their primary care physician, Phillips says patients will likely see better outcomes in their overall health. “Mental health disorders complicate the care of patients with any chronic medical condition, such as diabetes or heart failure,” he says. “If you’re depressed and feeling overwhelmed, it’s much more difficult to monitor your health and to take your medications.”

• Reduced physician burnout – “I have been a primary care physician for 35 years and for many of us it can feel very lonely because often we’re working by ourselves,” Phillips says. “We don’t have resources. We have patients come to us with problems that we may not feel prepared to address. A way that this new program will be particularly helpful is we’ll also be providing trainings for teams within primary care practices to increase their level of expertise in caring for mental health disorders.”

• Reduced costs of care – “We know treating depression can improve outcomes, which will reduce emergency room visits and hospitalizations,” Phillips says. “Often times costs for patients with diabetes who also have depression are increased by about 20%. If you treat that depression, you can save that amount in addition to making patients healthier and feel better.”

Even though this program is grant-funded, Phillips predicts that it will be financially sustainable over time, and he hopes the results will encourage other primary care practices to consider offering these services.

“One of the things we anticipate is there will be a positive return on investment, meaning the money we spend will be less than the savings that will be accrued by providing these services,” says Phillips. “So it will be a win-win for organizations to take on providing these resources in the future. We anticipate there will be new payment systems through accountable care organizations, and institutions will have the opportunity to commit resources to areas where they’ll achieve cost savings.” 

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