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How to Integrate Clinical Care with Mental, Behavioral Healthcare

Mental health and clinical outcomes are inextricably linked, but how can healthcare organizations overcome integration barriers to improve holistic, coordinated patient care?

How to integrate clinical care with mental healthcare

Source: Thinkstock

By Jessica Kent

- As the industry continues its shift from volume to value, healthcare organizations should consider innovative strategies for incorporating mental and behavioral healthcare services with the clinical environment.

Delivering high-quality, preventive care requires clinicians to treat the whole patient, on both the physical and behavioral level.

Research has shown that mental health issues are strongly correlated with chronic disease, and that leaving mental illness untreated can result in a wide range of issues, including medication non-adherence, increased mortality, and higher care costs.

With nearly one in five US adults experiencing a mental illness each year, holistic patient care that blends clinical and mental healthcare is a critical component of success for population health management.

Although the healthcare industry has made strides in merging physical and behavioral services, integration remains a difficult task.  

READ MORE: Mental Health, Primary Care Integration Cuts Depression Scores

Significant barriers, including a lack of health IT, insufficient data exchange, and limited resources, all hinder the incorporation of behavioral and clinical services in the primary care setting and elsewhere.

How can healthcare stakeholders overcome these challenges to truly integrate mental and clinical wellbeing and improve population health?

Increase adoption of health IT among mental healthcare providers

Although the electronic health record (EHR) has become the standard for the vast majority of clinical organizations, behavioral health providers have been slow to adopt the technology.

Clinicians in the mental health and behavioral health spaces are largely ineligible for the EHR Incentive Programs and may not find suitable offerings from mainstream health IT developers.

READ MORE: Mental Health Care Disparities Impact Population Health

This technology gap not only limits large-scale analytics of digital behavioral health data, but also prevents behavioral health providers from exchanging information across medical practices and integrating with primary care.

To improve EHR adoption in the mental health space, behavioral health clinicians can work together to alleviate concerns about workflow burdens and demonstrate the value of EHRs in enhancing patient outcomes.

A recent study published in AHIMA’s Perspectives in Health Information Management found that taking extra time to explain the utility of the EHR to behavioral health clinicians helped to ease resistance to adoption.  Clinicians were more likely to express positive attitudes towards the technology once they clearly understood how it could potentially enhance their workflows without becoming a barrier in the patient-provider relationship.

Organizational leaders working to convince providers that health IT can help may wish to look to successful programs that leverage digital tools to improve patient outcomes.

For example, a partnership between Walgreens and Mental Health America (MHA) offered patients access to an online platform on which they could participate in mental health screenings, and the initiative led to significant improvements in mental health detection and treatment.

READ MORE: Social, Behavioral Data Must Be Included in EHRs, Nurses Say

Seventy-five percent of patients who visited the platform completed the screenings and took the necessary steps to manage any detected conditions.

Thirty-seven percent of patients who accessed the platform followed up by reaching out to a mental health professional, and 24 percent shared their results with their healthcare providers.

Encourage health information exchange between provider types

Increasing health IT use in behavioral health settings is just the beginning, however. To truly integrate clinical and behavioral care, providers from both types of practice will need to enhance the exchange of patient data.

Several challenges stand in the way of seamless behavioral health data exchange, including security and privacy rules and technical barriers.

In its 2015 report to Congress on health IT adoption, the ONC found that office-based physician information sharing with behavioral health providers represented a mere 11 percent of all health data exchange activities.

Just 28 percent of hospitals reported sending care records to behavioral health clinicians, while 16 percent reported having received this information.

Primary care providers must be aware of patients’ behavioral health treatment data to avoid incomplete patient records and fragmented care delivery.

To increase data exchange between behavioral and primary care organizations, healthcare stakeholders at both the federal and state levels can support targeted strategies that improve information sharing.

For example, HHS recently issued a final rule to reduce the stringency of policies surrounding the exchange of certain behavioral health data, allowing patients receiving treatment for substance abuse disorders to participate in integrated healthcare models.  

At the state level, several initiatives have aimed to improve behavioral health data exchange and care coordination.

Maine’s state health information exchange (HIE) has allowed primary care physicians, hospitals, and behavioral health providers to access and exchange patient records and receive real-time notifications. The system enrolled 20 behavioral health organizations across 75 locations in 2015, leading to improved care integration for close to 3000 patients.

Devote additional organizational resources to mental healthcare

Despite the growing emphasis on holistic patient care, many organizations struggle to access the resources necessary to deliver such treatment.

A 2016 survey of accountable care organizations (ACOs) found that 89 percent said they had trouble funding mental health programs.

Additionally, only 32 percent reported that their communities had adequate resources to partner for value-based population health.

This lack of resources has created difficulties for mental health patients.

For example, an NYU study recently showed that the number of patients experiencing serious psychological distress (SPD) is growing. However, their access to treatment is shrinking, with 10.5 percent of SPD patients having experienced treatment delays in 2014, up from 9.5 percent in 2006.

Increasing patient access to mental healthcare will require stakeholders to expand their resources and consider new methods of care delivery.  

Payers can leverage their relationships with community mental health organizations to integrate mental and physical wellness support into existing care settings.

Organizations can also train staff members in wellness principles and use self-management strategies to aid patients with serious mental illnesses.

Researchers recently used this approach in Pennsylvania and found that providers’ development of wellness goals improved, as did patients’ use of self-management tools.

Both patients and providers also showed increased confidence and involvement in working toward improved health.

To further increase patient access to mental health services, organizations can enlist the skills of multidisciplinary care teams.

Nurse practitioners (NPs), physician assistants (PAs), and registered nurses (RNs) can all make significant contributions to population health teams and care coordination.

These professionals have strong connections to patients, often practice in community-based settings, and are a strong force in the healthcare community.

Recent research shows that the majority of individuals in these roles believe they will play a larger role in patient management and care coordination within the next five years, indicating that these providers may be an untapped resource for improving treatment access for mental health patients.

The integration of mental health and clinical care will be critical for organizations seeking to implement value-based care models.

By enhancing health IT use, data exchange, and organizational resources, healthcare stakeholders can support the coordinated and holistic care that is necessary for improved patient outcomes and population health. 


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