Behavioral Health

Why It’s Vital to Integrate Medical and Behavioral Health Services

December 19, 2018

Patient sitting on a couch while physician fills in form to strategize integrated physical and behavioral health plan.

As the relationship between medical and behavioral health becomes better understood, research indicates that patients suffering from mental illness and/or conditions such as eating disorders, drug dependency, alcoholism and addiction benefit most from integrated care, which addresses the patient’s physical and mental health needs with equal credence. 

While mental health illnesses and conditions can be as life-threatening as a medical condition, researchers continue to advocate for increased resources and comprehensive insurance coverage for the mental health aspect of patient treatment.

The Cost Of Keeping Medical And Behavioral Health Services Separate

A report written by global healthcare company Cigna outlines the increased need to collapse the space between these two types of services, noting high costs, barriers and effective patient care. Citing a 2014 study developed for the American Psychiatric Association, the paper reports that “individuals with co-occurring behavioral and medical conditions incurred almost $300 billion in additional health care costs. It is estimated that between 9-16 percent of this additional spending could be saved through effective integration of behavioral and medical care.” This would save an approximate $26-48 billion in costs within the health care community.

Primary Care Alone Doesn’t Solve The Problem

Another component of the case for integrated care is the issue of incorrect mental health diagnoses from primary care physicians. According to an extensive 2009 study, conducted through meta-analysis of 118 additional studies documenting the diagnosis of depression in primary care settings, only 47.3 percent of depression patients were correctly diagnosed.

Further, federal budget cuts and lack of access to resources have resulted in significant barriers that dissuade patients seeking mental health and integrated treatment. The Health Resources and Services Administration of the U.S. Department of Health and Human Services estimates that 89.3 million Americans live in “Mental Health Professional Shortage Areas,” particularly in rural communities. Also estimated was the number of Americans who have limited access to primary care, which sites at 55.3 million.

How Does Insurance Coverage Factor In?

The passage of the Affordable Care Act required a few plans to cover mental health services, including all plans offered through the Exchange, and made it illegal for insurance companies to turn down patient coverage due to the presence of a mental health condition, treated as a pre-existing condition. However, a 2015 report by National Alliance on Mental Illness (NAMI) found that insurance companies still denied mental health claims for 29 percent of survey respondents, far more than the number of medical treatment claims denied.

Cumulatively, the data suggests that many insurance companies are still not prioritizing mental health resources for their insured. The result is that oftentimes patients who need mental health treatment go without it. Statistical data gathered by the Patient-Centered Primary Care Collaborative (PCPCC) shows that “67 percent of people with a behavioral health disorder do not get behavioral health treatment,” and “30-50 percent of patient referrals from primary care to an outpatient behavioral health clinic do not make the first appointment.”

The Solution: What Integrated Health Services Could Look Like In Practice

In order to solve the aforementioned issues, implementing a system of integrated medical and behavioral health must begin by eradicating barriers that keep them separate. This way, a patient undergoing treatment for substance abuse, for example, would have access to synergistic medical and psychiatric treatment that addresses all components of the illness, ensuring a lower risk of relapse. Insurers that embrace this model and broaden their behavioral health offerings to patients enable easier access to the vital mental health services they need. Finally, funding additional research to quantitatively explore how to effectively treat medical and mental health issues will further highlight the need for this type of care.  

To read more about the importance of behavioral health integration, please visit the AMR Blog.

Why It’s Vital to Integrate Medical and Behavioral Health Services