Evaluation of a continuum-based behavioral health integration framework among small primary care practices in New York State: practice and policy findings and recommendations
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Behavioral health integration issue brief series
- Author(s):
- Chung, Henry, author Smali, Ekaterina, author Goldman, Matthew L., author Pincus, Harold Alan, author
- Contributor(s):
- Montefiore Health System, issuing body. New York State Health Foundation (NYSHealth), issuing body. United Hospital Fund of New York, issuing body.
- Publication:
- [New York, New York] : United Hospital Fund and New York State Health Foundation, February 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated Mental Health Services Primary Health Care New York United States
- Genre(s):
- Technical Report
- Abstract:
- The shortage of affordable and accessible behavioral health providers across New York State (NYS) leaves many people's depression and other behavioral health conditions undiagnosed and untreated. This service gap calls for solutions that help integrate behavioral health care in primary care (PC) settings to take advantage of the significant role that primary care providers (PCPs) can play in diagnosing and treating these conditions and facilitating referrals for those with more complex treatment needs. Adding to the roles and tasks expected of primary care practices leads to an array of challenges, however, including obtaining buy-in by both PCPs and behavioral health providers (BHPs). Key concerns include whether primary care practices have the capacity to respond to the clinical demands of addressing the behavioral health needs of potentially large numbers of newly screened and identified patients. Many PCPs may not have the practice infrastructure or access to referral networks to adequately treat complex mental health disorders, and not all PCPs are comfortable with managing behavioral health (BH) medications. For their part, BHPs have traditionally worked, in many siloed health care systems, without significantly interfacing with PCPs. And, for both PCPs and BHPs, sustainability of integrated care is a challenge, marked by confusion about how and when to bill for BH services in primary care and inadequate reimbursement for time devoted to care coordination between BH and PC settings. In response to these challenges, NYS has launched new behavioral health integration (BHI) initiatives and tackled regulatory modernization to help build PCP capacity for treating BH conditions, as a core strategy for improving access to and quality of care. Although evidence-based integration models have been demonstrated to work well when properly implemented, PCPs need practical guidance on the steps they can take to build integrated practice models. Small and medium-sized practices, in particular, face major challenges to BHI, given time limitations and resource constraints. To address these issues, our team developed a Framework to guide primary care practices in the development and implementation of operational plans aimed at achieving effective, evidence-based integration. The utility of the Framework is based on the premise that implementing BHI is best achieved through a stepwise and progressive process. Not all practices are able to achieve all aspects of advanced BHI, but they can still improve their ability to offer higher-quality BH care to their patients through incremental changes. The Framework was designed to help practices organize their integration efforts by assessing and building on existing strengths and priorities. Based on a targeted literature review and input from diverse stakeholders, the Framework, as tested, consists of 8 domains and 14 sub-domains that address the core elements of BHI. Each sub-domain is broken down into incremental steps marking preliminary, intermediate, and advanced stages of integration. This continuum allows practices to identify their current level of BHI within each domain and set goals to increase their BHI capabilities in different components of integrated care at different rates. While it is important for practices to strive for fidelity to evidence-based BHI models to ensure quality and efficacy, gold-standard models are often out of reach for smaller practices. This stepwise approach meets primary care practices where they are by presenting BHI as an incremental, more feasible implementation process.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (x, 48 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101770955 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101770955