The Importance of Integrated Health Care

Updated: Feb 24, 2019

By Vidhya Pathy, Copy Editor



In 2016, the United States government spent 3.3 trillion dollars on health care. Despite this, the American population is the sickest it has ever been — almost half of the population is afflicted with one or more chronic diseases. At the same time, one in five adults experiences mental health issues in any given year. However, 68% of adults with a mental health conditions also have a physical ailment. Naturally, this leads us to question: why do we address the two with completely separate healthcare systems? As a nation, we should be utilizing integrated health care, since treating mental illness and physical health as separate entities is counterproductive and needlessly expensive.


What is integrated health care? According to the State Innovation Model, a healthcare delivery reform initiative in Colorado, integrated health care is the combination of mental and physical health upkeep in primary care settings. In practice, this means that the entire medical team is necessary in successfully integrating behavioral health care. First, the primary care team consists of the staff who receive patients, including receptionists and medical assistants. The next level of care is provided by nurses who take the patients’ basic vitals and examine their medical history. Then, the physician talks with the patient and diagnoses them with a new health condition or modifies prescriptions for existing health conditions. Finally, there is the behavioral health professional (BHP). This person is likely a Psy.D. (doctor of psychology), LCSW (social worker), or LPC (professional counselor).


Care starts with the receptionist, who will note patient symptoms and look for indicators of common mental health issues. The receptionist will also administer screening for depression (PHQ-9) and anxiety (GAD-7). The front-line staff give completed screenings to the nurses, who will review them before seeing the patient. The nurses’ job is to build trust with patients. The nurses talk to the patients about their responses to the aforementioned surveys. If a patient has a high score, then the nurse will begin to talk about history with the condition and ask if the patient has ever used medication for this ailment. Nurses will also discuss physical conditions that are typically comorbid with patients’ mental health concerns. Next, the doctor will briefly converse with the patient and determine what treatment path is best. Whether the solution includes drugs or not, the physician will introduce the patient to a behavioral health professional on site. The BHP will discuss further treatment options during the same visit to ensure compliance.


An increasingly popular approach to care delivery, integrated health care is being implemented in many states across the US. According to a study conducted at the actuarial firm Miliman, “Effective integration of general medical and behavioral health care could save 26-48 billion dollars in U.S. health care costs each year.” While more research is needed to demonstrate the cost-effectiveness of integrated care, there is a growing movement across the country to provide more holistic care as more providers realize the potential benefits of treating the mind and the body together.


References:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

https://www.integration.samhsa.gov/workforce/mental_disorders_and_medical_comorbidity.pdf

https://www.colorado.gov/pacific/healthinnovation/what-is-sim

https://www.milbank.org/publications/evolving-models-of-behavioral-health-integration-evidence-update-2010-2015/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476048/

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.655News1?fbclid=IwAR2xuXzCe_T7_7oxx0-aQFnlu-3ACustKo9zXssQ43ToJzdF18nbfL2YDVs&

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