Bridging the Gap in Primary Care: Behavioral Health Integration Best Practices

Ample research demonstrates that integrating behavioral health services into physical medicine practices supports holistic health improvements, including chronic disease indicators, by improving quality and increasing access to care for patients with mental health conditions. Despite the benefits, implementing this approach is no easy feat. Up front costs in terms of staffing, training, and technology investments may seem burdensome. If providers fail to implement integrated care correctly, they may not reap the full benefits. Luckily, with the right processes in place, providers can limit costs and improve the effectiveness of integrated care. Below are behavioral health integration best practices to facilitate better patient outcomes while achieving both time and cost savings. 

Assess Your Readiness for Behavioral Health Integration

It’s possible your healthcare organization already has some of the tools and processes in place to transition to integrated care. Perhaps the organization is already providing some behavioral health services but has yet to fully integrate them with physical healthcare. Or care teams may already use a centralized patient database, which can improve the effectiveness of delivering integrated care.

There are many tools available to assess leadership, administrative, and technological readiness for integrated behavioral health. A great place to start is with the Substance Abuse and Mental Health Services Administration (SAMHSA) BHI assessment toolkit, developed in partnership with the National Council for Behavioral Health. The toolkit includes helpful frameworks to prepare healthcare providers to gradually implement and improve integrated care within their organization.

NeuroFlow also developed a short, four-minute behavioral health assessment which you can take here. The assessment will help your organization identify its level of readiness for integrated care, given current processes and workflows, and will help you identify areas of improvement.

Choose a Behavioral Health Integration Model

Integrated care is not one size fits all. Population needs and provider capabilities vary significantly. Luckily, several models have been the subject of rigorous research and have been proven to improve patient well-being. Following are three vetted models you may want to consider for your organization:

  • Primary Care Behavioral Health (PCBH) ModelThis model is often recommended to providers with a large patient population. In this model, a behavioral health consultant (BHC) receives warm patient handoffs or referrals from the primary care physician. Ideally, the BHC is a part of the care team and provides consultations to care providers and brief interventions with patients in the context of the physical medicine visit. 
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) – This is a public health approach intended to identify and support patients with risky substance using behaviors. Initial encounters occur within primary care, trauma centers, or emergency rooms and allow providers to intervene early with patients who are at risk for substance abuse disorders. This model requires close partnerships between behavioral health and physical health facilities.  
  • Psychiatric Collaborative Care Model (CoCM)CoCM requires the implementation of a care team which includes the primary care provider, a behavioral health care manager, and a psychiatric registry consultant. The psychiatric registry consultant provides weekly consultation to the behavioral health care manager, discussing patients who may need greater support and making treatment and psychotropic medication recommendations. The care manager provides brief interventions with patients while the PCP prescribes medication if needed.

Identify Metrics for Success

Measurement is a key part of successful integrated behavioral health. The first step of effective measurement is understanding how patients with mental health conditions are currently served by your organization and the associated clinical outcomes. Behavioral health related HEDIS measures offer an important place to start, as these measures have been identified by payors as quality and outcome measures of importance within shared savings and quality bonus arrangements. Aligning your integrated care program with these measures will help you establish strategic goals and a baseline for improvement.

Next, identify how you will measure success going forward. In its Behavioral Health Integration Compendium, the American Medical Association (AMA) offers some common metrics for integrated care success:

  • Distribution of assessments like PHQ-9 and GAD-7
  • Referral completion percentage
  • Appointment adherence
  • Patient assessment scores over time
  • Reduced emergency department visits
  • Financial sustainability (immediate charting, claim approvals, reduced denials)

Prepare Your Team for Behavioral Health Integration

Creating new workflows is an important part of the integrated behavioral health process and ensures that mental and physical health are addressed holistically within your organization. Those new workflows may require additional staff, training, or partnerships with service providers.

Effective change management is also critical to a successful integrated care program. Identify and nurture internal champions who will advocate for new workflows and lead adoption within your teams. Consider how workflows will be implemented across departments and which key stakeholders will be responsible for those handoffs. Finally, a pilot program may improve adoption and implementation within your organization by demonstrating success and identifying process improvements prior to the widespread rollout of integrated care.

You may need additional staff members to execute these processes. Some common roles include:

  • Primary Care Provider
  • Behavioral Health Care Manager or Specialist
  • Behavioral Care Billing and Coding Specialist 
  • Caseload Supervising Psychiatric Provider
  • Program Administrator

Some team members, particularly those who are based in primary care, will need additional training on how to administer behavioral health screenings, what steps should be taken after a positive screening, and how to communicate and implement a treatment plan. There are several online trainings available for care providers to help with the transition to integrated care.

Your workflows will depend on your model of integration, provider buy-in, and technical capabilities. No matter the model, the first step is developing comprehensive workflows that maximize your universal screening rates to identify patients with behavioral health conditions. Through universal screening of your patient population, your integrated behavioral health staff can risk stratify and triage patients to the appropriate level of care. Within these models, ongoing oversight is managed by the physician with support from a BH care manager or BH Consultant. AMA offers some helpful examples of how that workflow might look and what roles are involved at the different stages of care.

Engage the Patient in Their Behavioral Health

Patient centered care is an essential tenet of integrated care. Early and regular communication with the patient about the importance of a holistic approach to health encourages active participation and leads to improved whole-health outcomes. Having these ongoing conversations will also alert you to changes in patient well-being and will guide more tailored care plans.

When building a treatment plan for a patient with a mental health condition be sure to involve them and their family directly in that plan and set expectations for what progress will look like. This helps destigmatize mental health conditions and ensures the patient takes an active role in his or her behavioral health. 

Implement Behavioral Health Integration Billing & Coding

Financial sustainability is necessary to ensure long-term provision of behavioral health support while meeting the rapidly growing need for mental health services. In order to make integrated behavioral health services sustainable within fee-for-service (FFS) arrangements, providers should incorporate integrated care CPT codes when billing insurance companies. Even for health systems that are transitioning toward a value-based care (VBC) arrangement, billing with integrated care codes can help systems achieve financial sustainability before VBC cost savings take effect. You can find a list of behavioral health integration codes provided by AMA here, but some common codes to be aware of include:

  • 99484 – General Behavioral Health Integration Care Management
  • 99492-94 – Psychiatric Collaborative Care Management
  • 96127 – Mental Health Screening

Whether you are working with commercial insurers, Medicare, or Medicaid, behavioral health services are increasingly prioritized by many payors because of their impact on overall health and well-being. It will be important to familiarize yourself with these codes and your payor mix to inform your financial and sustainability modeling.

Although the effectiveness of integrated care is well-documented, many providers have yet to adopt an integrated approach, often due to limited time or a lack of implementation knowledge. With these integrated behavioral health best practices, your organization can streamline the planning process and scale implementation so that you can make an immediate, positive impact on your population’s mental and physical well-being.

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