New pilot integrates behavioral health and primary care to improve patient outcomes
For more than a year the COVID-19 pandemic has influenced all aspects of life, often in overwhelming and stressful ways that negatively impact both mental and physical health while also creating barriers to care. From economic uncertainty to social distancing, feelings of stress, isolation and anxiety were all too common. Even as vaccines have made it possible for life to begin returning to normal for many, stress and anxiety persist.
A 2020 report from the Centers for Disease Control and Prevention found that 40 percent of adults in the U.S. were struggling with their mental health or substance use. But even before the pandemic, the U.S. was facing a mental health crisis. In fact, from 2017-2018, 19 percent of adults experienced a mental illness — an increase of 1.5 million people from the previous year. During that same timeframe nearly a quarter of adults with a mental illness reported an unmet need for treatment, a number which has not declined since 2011.
To offset this crisis, improve outcomes and lower costs, a new collaboration in Rhode Island between primary care physicians and behavioral health specialists is making it easier for patients to receive the physical and behavioral health care they need, when they need it.
The two-year pilot program from Blue Cross & Blue Shield of Rhode Island (BCBSRI) looks to align provider payment with quality and cost efficiency. Centered on the Collaborative Care Model, BCBSRI and Lifespan’s Women’s Medicine Collaborative — the first health care provider to participate in the pilot — will develop shared care plans focused on improving patient outcomes and access.
Launched in April 2021, the pilot program provides an alternative payment model for integrated behavioral health care provided using the Collaborative Care Model. The arrangement also has additional funding for reporting on quality measures related to member participation in the program and warm handoffs between clinicians. The Collaborative Care Model uses a short-term, solutions-based treatment approach to address behavioral health conditions in primary care before they escalate to the point where specialty care is needed. The model utilizes a consulting psychiatrist who provides consultation and direction to the primary care physician as needed. With more than 1 in 5 women experiencing a mental health condition in the last year, this program is addressing a critical care need.
“While many behavioral health conditions such as depression and anxiety are often treated in a primary care setting, by integrating behavioral health we aim to offer the care, support and education patients need to ultimately improve both their experience and outcomes,” said Rena Sheehan, MBA, LICSW, vice president, clinical integration, BCBSRI. “We know that integrated behavioral health and primary care has demonstrated positive impacts to the quadruple aim to improve the experience of care, improve the health of populations, reduce the per capita costs of health care and improve the work life of health care providers.”
The success of the pilot will be measured by how it improves patient outcomes. A key component of the program is coordinated care between the physician and behavioral health specialists, including real-time access to behavioral health treatment and care management at the time of screening, whether in-person or virtual. The high-touch, highly coordinated model will provide the education and support needed for patients to make better informed treatment decisions, increasing their engagement and improving outcomes. The program will also measure adherence to prescribed antidepressant medications.
“Under the Collaborative Care Model, primary care and behavioral health providers are able to partner on shared care plans that incorporate the same goals — improving access to care and improving patient outcomes,” added Sheehan. “This new pilot program allows us to better capture the population health management and care coordination components critical to successful integrated programs.”
“We know that integrated behavioral health and primary care has demonstrated positive impacts to the quadruple aim to improve the experience of care, improve the health of populations, reduce the per capita costs of health care and improve the work life of health care providers.”
BCBSRI is an independent licensee of the Blue Cross Blue Shield Association.
