Caring for the whole person. That is the guiding principle for why primary care services and behavioral health services should be integrated in our health care system. Unfortunately, the funding for these services, the service delivery, the service policies, and the education and training of physical health and behavioral health providers are different. At all levels, the systems designed to deliver primary care services and behavioral health services were built separately and without coordination.
The data that is emerging, driven largely by local initiatives and pilots, there is strong evidence now that the integration of behavioral health with physical health care “improves health care access, minimizes stigma associated with seeking mental health services, increases overall health outcomes, and lowers health care costs.”1 This movement to integration is particularly significant for the Medicaid system as a large portion of the medical expenses in Medicaid are driven by behavioral health needs. According to the Kaiser Family Foundation, more than 9 million Medicaid beneficiaries had a mental illness and more than 3 million had a substance use disorder in 2015.2
Policy is starting to catch up to the data and evidence with an increasing amount of both federal and state legislation recently introduced and/or signed into law that support integration. As of January of this year, 30 states have integrated the financing of behavioral health in their Medicaid managed care health plans.3 As states consider or implement integration, they should consider some critical program design features to ensure high quality services, improved outcomes, and sustainable programs.
- When integrating delivery systems, states should include a comprehensive package of behavioral health services to ensure the holistic mental health and substance use needs an individual can be met.
- States should leverage their Medicaid managed care organization partners in the management of these integrated services.
- In addition to integrating services at the health plan level, states should consider policies that support provider integration such as same-day billing, integrated health records, and cross-training of providers.
- States should remove the barriers that exist between behavioral health and primary care administrative systems, including licensing, information technology, contracting, and eligibility, in order to fully support integrated services.
As the movement to integrate behavioral health and primary care continues, the next step is to incorporate non-clinical or social needs into the delivery system to provide a truly holistic, person-centered approach to care. If caring for the whole person is our goal, considering a person’s head, heart, and home as part of our approach to care should be the rule and not the exception.
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