Integrated behavioral health and primary care services clearly remain a work in progress in most communities, judging from responses offered by attendees at a Sept. 22 breakout session at the National Conference on Addiction Disorders’ (NCAD’s) Behavioral Healthcare Leadership Summit.
A roomful of hands shot up when two leaders from the National Council for Behavioral Health asked how many individuals’ organizations were offering integrated care. But a smaller number were raised when it was asked how many centers are routinely testing patients for metabolic syndrome. And still fewer responses were offered when presenters asked the audience why indeed their organizations were integrating behavioral health and primary care services in the first place.
Kathleen Reynolds, MSW, the National Council’s vice president of integrated health and wellness, and Aaron M. Williams, director of substance abuse training for the National Council-managed SAMHSA-HRSA Center for Integrated Health Solutions, discussed the promise of the health homes concept in health reform for substance use treatment organizations. They said that the staggering mortality numbers for individuals with serious behavioral illness—a mid-40s average age of death in the co-occurring disorders cohort—makes the concept of an integrated care model a no-brainer.
But for an addiction treatment provider to be at the helm of a health home model, it must meet several requisites in its operations, they said, including:
· Allowing patients to make appointments easily and be able to select a preferred day and time.
· Keeping any wait times for services short.’
· Having e-mail and telephone consultation available to patients.
· Making off-hours services available.
Only about one-third of attendees in the breakout session answered yes when asked if their organizations currently offer same-day or next-day services to those making a first inquiry. Wait times are seen as a significant barrier to integration with primary care because it is believed that physicians will not want to partner with organizations to which they cannot immediately refer someone.
“If I have a sore throat and I call my doctor, he’s not going to say, ‘I have a sore throat intake group next Wednesday, so come back then,’” Reynolds said.
Reynolds and Williams say the expectations around health homes in the Affordable Care Act (ACA) are proving to offer a boost for substance abuse treatment. Reynolds said that in Maryland, opiate treatment programs have received the opportunity to achieve health home designation. Williams added that advances in medication-assisted treatment hold promise for more effective care, though this could go unfulfilled if communities aren’t equipped to offer rapid access to the accompanying counseling that is critical to medication treatments’ ultimate success.
Reynolds also warned that co-locating addiction and primary care services does not always suggest true integration, because if they are situated on separate floors they might as well be located in separate counties.
The speakers pointed out a Center for Integrated Health Solutions website in which individuals can access state-by-state breakdowns of the accepted billing and diagnostic codes for integrated behavioral health and primary care services.