- A behavioral health home model is an effective strategy for integrating mental and behavioral health into primary care services, according to a new initiative at the University of Pittsburgh Medical Center (UPMC) Center for High-Value Health Care. In doing so, medical home providers can enhance patient activation in their own physical and mental healthcare.
The initiative, which was discussed in a recent Health Affairs article, included two behavioral health medical home models. Built off the foundation of traditional patient-centered medical homes, these two models integrate the work of 11 community mental health providers in Pennsylvania. One model was patient self-directed and the other was provider-directed.
The patient self-directed model grants patients access to an online portal filled with patient education materials. Patients in this cohort also have access to behavioral health specialists, wellness coaches, and paper-based patient education.
The provider-directed model uses certified nurses and community health providers who deliver patient education on-site. Nurses also work as patient navigators, helping to coordinate wellness visits, specialty services, preventive care, and other wellness supports.
Both models sought to address patients with serious mental illness who are at higher risk for chronic illness and short lifespans.
"Adults with serious mental illness have a decreased life expectancy of up to 25 years compared to the general population and are often faced with a combination of high medical need and challenges in accessing high quality medical care," said lead author James Schuster, MD, chief medical officer for Medicaid, special needs, and behavioral services at UPMC Insurance Services Division.
"Often, these individuals are at high risk for chronic disease, which makes the integration of behavioral health and physical health critically important,” Schuster added.
The behavioral health medical home combines both mental and behavioral health specialists with primary care and other physical health providers. The model aims at integrating these services to create a holistic approach to health.
Specifically, the behavioral health medical home model advocates for healthy lifestyle habits, disease prevention, health education, and other strategies that address downstream determinants of health. Both the physical and mental elements of patient health go hand-in-hand, and the behavioral health medical home model seeks to address that fact.
“Services for members can include access to on-site wellness nurses and disease self-management tools and resources,” UPMC explained in an article about the medical home model. “Supports for providers may include patient registries and avenues for increased collaboration with physical health providers — on top of training all behavioral health provider staff in wellness training and coaching.”
Both behavioral health medical home models improved patient activation in care, the researchers reported. Patients in both groups experienced a two-point increase in their patient activation measure scores, although patients in the provider-led cohort saw that increase sooner.
Patients also increased usage of preventive care services by 36 percent.
These results indicate that integrating behavioral and physical health in a medical home model is an effective strategy for activating patients in all elements of their health.
"The results of this important study can positively impact the way physical and behavioral health care services are delivered to patients with serious mental illness in Pennsylvania and beyond," said David Kelley, MD, chief medical officer at the Pa. Department of Human Services' Office of Medical Assistance Programs.
"This model demonstrates the value of Pennsylvania's approach to behavioral health services for Medicaid members, which encourages close collaboration between patients, providers, county-based human service programs, and managed care organizations,” Kelley explained.
This may help answer a call made all around the healthcare industry to integrate behavioral health with primary care. A recent survey from the NEJM Catalyst Insights Council found that the lack of integration between mental health and primary care is stunting patient access to mental healthcare.
A total of 14 percent of healthcare professionals responded to the survey that their organization offers no mental health support at all. Although three-quarters of respondents said their organizations offer a basic screening, very few said they offer any specific mental or behavioral health support.
Healthcare organizations should not simply layer behavioral healthcare over pre-existing primary care services. Instead, a community health needs assessment (CHNA) can pinpoint the specific downstream health factors that a medical home should address.
By creating a comprehensive mental and physical health offering, healthcare professionals can support better patient access to care.
“Clinicians should be able to easily access and share information about patients, enabling different specialties to work together to create comprehensive treatment plans,” the NEJM Catalyst report stated. “Doing so would also more easily allow the integration of primary care services into psychiatric services, which 81 percent of survey respondents enthusiastically support.”