A new guide will help primary care practices increase their ability to serve patients with mental health issues within their primary health care settings. The framework delineates a series of steps—identifying preliminary, intermediate, and advanced stages of eight different components, or domains, of practice integration—allowing practices of different sizes to track and make progress at their own speed based on resources and practice structure.

The eight domains around which the framework is structured are case finding, screening, and referral to care; use of a multi-disciplinary professional team to provide care; ongoing care management; systematic quality improvement; decision support for measurement-based, stepped care; culturally adapted self-management support; information tracking and exchange among providers; and linkages with community/social services.

Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework delineates the steps to advancement within each domain, and provides broader guidelines on getting started, including prioritization of domains, articulation of goals, and determination of existing and potential resources.

As the guide notes, behavioral health disorders contribute to decreased quality of life and increased health care costs, yet they frequently go undiagnosed and untreated, with only 22 percent of adults with common mental health disorders receiving care. Even when conditions are identified by primary care providers, patient follow-up on referrals is low. These factors make increasing capacity for treatment of behavioral health conditions in primary care settings a core strategy for improving access to and quality of care. 

“While integrating behavioral health care into primary care is seemingly every provider’s current goal, the available guidance doesn’t sufficiently take into account the varying types of primary care practices, which often have different resource limitations and are at different stages in the process,” said lead author Henry Chung, MD, vice president of Montefiore’s Care Management Organization, medical director of Montefiore’s Accountable Care Organization, and associate professor of clinical psychiatry at Albert Einstein College of Medicine. “We wanted to create a framework that was flexible enough to work with a range of practices, and powerful enough that any practice could follow it and make thoughtful progress.”

The framework is grounded in a flow chart that traces progress, within the eight domains, as practices move from beginning to intermediate to advanced stages of behavioral health integration. It is intended to help practices get a better sense of the big picture at a glance and also guide them through the essentials of practice transformation.

“With so many alternative payment models being developed and the transition to value-based care, many physicians in practice, especially in primary care medicine, are eager for just this kind of guidance,” said Linda Lambert, executive director of the New York Chapter of the American College of Physicians. “While the framework will undoubtedly have relevance for large provider groups, we are pleased that this paper and its recommendations were designed with the flexibility to work for smaller practices and physicians who operate independently. If integrating behavioral health care into primary care practices is going to work, it has to work for the smaller practices as well, which the authors clearly understood.”

“Making primary care more robust through the integration of behavioral health services is a key component of health reform, but many primary care providers, especially smaller and medium-sized practices, are struggling without the tools to make this happen,” said Jim Tallon, president of United Hospital Fund. “I expect larger providers—including the Performing Provider Systems operating as part of New York State’s Delivery System Reform Incentive Payment program—and health plans and policymakers will also find it a useful framework for meeting some of their health reform–specific goals.”

Advancing Integration of Behavioral Health into Primary Care: A Continuum-Based Framework is the product of work conducted with grant support from United Hospital Fund. Published by UHF, it was written by Henry Chung, MD, Nina Rostanski, MPH, Montefiore Health System, government and community relations; Hope Glassberg, MPA, HRHCare Community Health, strategic initiatives and policy; and Harold Alan Pincus, MD, Columbia University and NewYork-Presbyterian Hospital, Department of Psychiatry. The publication is available free of charge from the UHF website at https://www.uhfnyc.org/publications/881131.