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Is the Mind Part of the Body? The Challenge of Integrating Behavioral Health and Primary Care in a Reform Era

Friday, May 02, 2014

As more people gain coverage that includes behavioral health benefits, and given a limited supply of mental health professionals, analysts and advocates are raising concerns over how and whether new laws and regulations will be able to change that situation. One option being explored in many settings is the integration of behavioral health services with primary care. There is early evidence that coordinating care in this manner may deliver high-quality care more efficiently.

For almost 20 years, bipartisan majorities in Congress have been legislating ways of bringing behavioral health services to the 62 million Americans in need of them. Beginning with the 1996 Mental Health Parity Act, Congress has steadily broadened access to these services.

All state Medicaid programs and plans sold on the health insurance marketplaces cover behavioral health services. Yet 60 percent of adults and 70 percent of children with a mental health disorder do not receive treatment. In children, the average time between onset and treatment of mental illness is nine years. And one in six adults has co-morbid mental health and medical conditions. More commonly their medical condition is being treated while their mental health condition goes undiagnosed and untreated.

Do current models of integrating behavioral and physical health hold promise? Are there enough providers to meet the demand of the newly insured? What is needed to help primary care fill the gap? How are states meeting the budgetary challenge in Medicaid programs? Is parity a reality?

A distinguished panel of experts addressed these and related questions.

Michael Hogan, former commissioner of the New York State Office of Mental Health, and chairman of President George W. Bush’s New Freedom Commission on Mental Health, provided a big picture overview of the status of behavioral health integration with medical care, and the impact on state Medicaid programs.  

Laurel M. Newman, quality implementation manager, Primary Care Clinical Program at Intermountain Healthcare, focused on initiatives and models that are working, and the challenges facing those who are implementing or hope to implement these models.

Nick Macchione, director of the San Diego County Health and Human Services Agency, highlighted the special challenges of serving the mental health needs of a very diverse population and of running an accredited psychiatric hospital in an environment of change.

Lonnie Fuller, center medical director at Baltimore Medical System, brought the perspective of a primary care physician and internist serving vulnerable populations and helping to develop integration strategies in Maryland.

Ed Howard of the Alliance and Bernard Engelberg of Cenpatico (Centene) moderated the discussion.

Follow the briefing on Twitter: #BehavioralHealth

Contact: Deanna Okrent (202) 789-2300

The event was sponsored by the nonpartisan Alliance for Health Reform and the Centene Corporation

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 5/2/2014
Full Webcast/Podcast: Full Video

Speaker Presentations

Engelberg Presentation (Adobe Acrobat PDF), 5/2/2014
Hogan Presentation (Adobe Acrobat PDF), 5/2/2014
Newman Presentation (Adobe Acrobat PDF), 5/2/2014
Macchione Presentation (Adobe Acrobat PDF), 5/2/2014
Fuller Presentation (Adobe Acrobat PDF), 5/2/2014

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 5/2/2014
Speaker Biographies (Adobe Acrobat PDF), , 5/2/2014
Materials List (Adobe Acrobat PDF), , 5/2/2014
Selected Experts (Adobe Acrobat PDF), , 5/2/2014

Offsite Materials (briefing documents saved on other websites)

Psychiatry a Key Player in Effective Health Reform, APA Says, Medscape, 4/4/2014
Can We Live Longer? Integrated Healthcare’s Promise, Substance Abuse and Mental Health Administration, 1/1/2012
Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry (Summary), Milliman, Inc, 4/1/2014
Healthcare Integration – the Behavioral Health Perspective, The Centene Corporation, 4/28/2014
Integrating Mental Health Services in Pediatric Practices Feasible, Effective, Pitt Finds, UMPC and University of Pittsburgh Schools of the Health Sciences, 3/24/2014
Integrating Physical and Behavioral Health Care: Promising Medicaid Models, The Henry J. Kaiser Family Foundation, 2/1/2014
‘Many’ Teens Struggle with Untreated Mental Illness, but School Screening Still Lacking., The Huffington Post, 1/13/2014
Integrating Behavioral Health Into Primary Care, Institute for Healthcare Improvement, 3/1/2014
Mental Health Parity, Health Affairs Blog, 4/3/2014
A New Emphasis on Telehealth, American Psychological Association, Monitor on Psychology 42;6, 6/1/2011
HIE Helps Integrate Behavioral and Physical Health Care, but Hurdles Remain, iHealthBeat, 4/1/2014
State Approaches to Integrating Physical and Behavioral Health Services for Medicare-Medicaid Beneficiaries: Early Insights, Center for Health Care Strategies, Inc, 2/1/2014
The ACA and Behavioral Health: A Look Ahead, Behavioral Healthcare, 3/18/2014
Integrating Physical and Behavioral Health: Strategies for Overcoming Legal Barriers to Health Information Exchange, Robert Wood Johnson Foundation, 1/14/2014
The Business Case for Behavioral Health Care, CSI Solutions, LLC, 1/1/2013
The PRIDE Initiative: Building the Capacity and Scalability of Integrated Managed Care Plans, Health Affairs Blog, 2/13/2014
Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes, Annals of Family Medicine 12;2, 3/1/2014
Fostering Sustainable, Integrated Medical and Behavioral Health Services in Medical Settings, Annals of Internal Medicine 160;1, 1/7/2014
Cost and Quality Impact of Intermountain’s Mental Health Integration Program, Journal of Healthcare Management 55;2, 3/1/2010
Role of Psychiatry in Health Reform: Summary Report, American Psychiatric Association Board of Trustees Work Group on the Role of Psychiatry in Healthcare Reform, 4/1/2014
A Law to Fix Mental Health Care, American Enterprise Institute, 12/22/2013
State Medicaid Best Practice: Telemental and Behavioral Health, American Telemedicine Association, 8/1/2013
The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes, Center for Health Care Strategies, Inc.; Mathematica Policy Research, 5/1/2013


Laurel M. Newman

Lonnie Fuller

Untreated childhood behavioral health issues cause half of chronic medical problems, Michael Hogan, former commissioner of the New York State Office of Mental Health, and chairman of President George W. Bush’s New Freedom Commission on Mental Health, stated at a May 2 Alliance briefing, Is the Mind Part of the Body? – The Challenge of Integrating Behavioral Health and Primary Care in a Reform Era.

Nick Macchione

Bernard Engelberg


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