AHIP: Next Steps Toward Primary, Behavioral Healthcare Integration

AHIP called on providers and policymakers to join payers in their efforts to integrate behavioral healthcare and physical healthcare in an issue brief on the subject.

The payer organization laid out three critical strategies for integrating behavioral healthcare. 

The collaborative care model (CoCM) uses care management to facilitate patient-centered care, and many of its services are recognized and reimbursed by CMS. 

The expanded and integrated care management model uses care management to support individuals with chronic conditions, specifically behavioral healthcare conditions. The model leans on screening tools in the primary care environment to identify conditions earlier.

Finally, the value-based purchasing and alternative payment models incentivize whole-person care financially. However, outcomes-based payment is challenging to measure in behavioral healthcare.

“There are several challenges to wider adoption of behavioral health integration that require broader stakeholder engagement,” AHIP explained. 

“These challenges include the size of the existing behavioral health workforce, the strength of available evidence and standards for assessing behavioral health care treatment and the consequent state of quality measures applicable to behavioral health conditions, and the readiness of providers to implement integrated care models.”

In response to these obstacles, the payer organization recommended policies that will draw new labor into the behavioral healthcare workforce, such as boosting loan repayment programs, expanding scholarships, and growing the types of behavioral healthcare providers covered by Medicare.

The academic system may also need to change. AHIP suggested multiplying the number of placements in graduate medical education and including integrated behavioral healthcare and care coordination into medical education.

Bolstering telehealth—which proved well-suited to addressing behavioral healthcare needs during the pandemic—may also support the currently flagging workforce. And leveraging hub-and-spoke models could amplify resources for behavioral healthcare programs.

AHIP recommended improving the evidence base for behavioral healthcare integration strategies.

In particular, the payer group mentioned that policymakers might improve federal funding for technical support for providers who are implementing CoCM. They can also support further research to improve the industry’s understanding of specific strategies’ efficacies. The industry also needs to work on developing better behavioral healthcare quality metrics.

Finally, in the public payer sphere, Medicare and Medicaid should move toward behavioral health integration with new incentives for certified community behavioral health clinics.

Lastly, AHIP stressed the need to support interoperability efforts. The push toward interoperability coincides with payers’ endeavors around behavioral healthcare integration.

To allow the two trends to support one another, AHIP recommended including behavioral healthcare providers in the Electronic Health Record (EHR) Incentive Program to promote integration. 

Also, AHIP asserted that federal and state policymakers should reform any policies that restrict access to behavioral healthcare, such as how privacy regulations are particularly strict for behavioral healthcare.

“Behavioral health integration promotes timely access to whole-person care,” AHIP concluded. “And in removing the traditional siloes between medical and behavioral care, integration can help reduce the stigma and disparities in care that often present challenges to equitable access to quality behavioral health care.”

Individual payers have been moving toward greater behavioral healthcare and physical healthcare integration in various ways. For example, in early 2022, Centene finalized its acquisition of a behavioral healthcare platform to integrate the two forms of care.

Other payers have focused on creating smoother data transfer between virtual care and in-person care, educating providers, improving member access to substance abuse care treatment information, minimizing hospital readmissions, and offering social interaction benefits to combat isolation.

Through these strategies and others, payers seek to not only improve behavioral healthcare access, but also behavioral healthcare integration into primary care services.