GJ takes lead in integration of behavorial, physical health

By MARY BETH BUESCHER

Of the many and various aspects of health care reform today, none inspires as much excitement as the promise of positive outcomes from integrating behavioral health (mental health and substance use disorders) with physical health.

Over the years, we have separated and isolated treatments for physical problems into specialties, resulting in an expensive lack of coordination of care. While it has long been recognized that there is a strong connection between mind and body, we nevertheless have separated mental health treatments from their physical components. Not anymore.

Rocky Mountain Health Plans and the Collaborative Family Healthcare Association, along with the University of Colorado Denver’s Department of Family Medicine, are partnering to provide citizens on the Western Slope with an integrated behavioral/physical health care model. If it succeeds, their efforts could transform the nation’s approach to treating the whole person. Research shows that treating behavioral health and physical health separately results in poorer outcomes and higher costs.

We have an excellent example of the integrated model right here in Grand Junction at the Marillac Clinic.

“After a dozen years of using the integrated care model, Marillac has learned that treating mind, body and spirit together leads to much better results,” said Kristy Schmidt, acting director at Marillac.

Patrick Gordon, director of Rocky Mountain Health Plans, adds that “Marillac is the best example of what we are trying to achieve with this project. Marillac has acted intentionally and intelligently to organize itself around the needs of the patient. Our goal is to expand the Marillac model across an entire community and all of its various populations.”

“Behavioral health issues, such as depression, not only directly affect patients’ physical health; they also affect it indirectly, impairing adherence with and attention to their treatment plan. People don’t heal as well or as quickly,” said Dr. Benjamin Miller. “Only through integrating the mind with the body can we truly make a difference in the lives of patients.”

Dr. Mike Pramenko of Primary Care Partners in Grand Junction adds that “Integration, while improving quality, can control costs by reducing unnecessary hospitalizations and emergency room visits.”

Since most people who experience depression, anxiety or other mental health conditions are seen at their primary care doctor’s offices, this is the best place to begin the effort of integration of care. Part of the Rocky Mountain Health Pans and Collaborative Family Healthcare Association effort involves overcoming the stigma of mental illness and placing it in the larger context of health care.

This partnership involves a three-year, multi-site pilot to test a global payment model of delivering care. Instead of payments based on the current practice of billing for each item of individual treatment, global payments provide the health care provider with a lump sum per year, with the medical provider receiving payment based on positive outcomes such as increased patient health, reduced hospital admissions and reduced costs. “It is important to note that we are talking about a cultural transition here, not just a new work scheme or a new payment scheme, but a change in how we view the patient,” Gordon said.

To achieve such outcomes, integration of behavioral and physical health is not only good practice, but imperative.

The global payment innovative project is funded by the Colorado Health Foundation. Six pilot sites located in Grand Junction and surrounding western Colorado communities will be selected to test this global payment model for financially sustaining integrated behavioral health care. The project should be under way by the spring of 2013.

Mary Beth Buescher is on the board of directors of Mental Health of America of Colorado.


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