Creating linkages between behavioral health and primary care

BOSTON—High-risk patients with comorbidities more often than not have mental health conditions, and several initiatives are underway to integrate behavioral health and primary care to more effectively treat these patients, according to speakers at the Center for Connected Health Symposium on Oct. 23.

At Massachusetts General Hospital (MGH), a pilot initiative that embedded behavioral coaches and psychiatrists in two primary care practices “was very successful,” said Susan Edgman-Levitan, PA, executive director at the MGH’s John D. Stoeckle Center for Primary Care Innovation. The project utilized population health management tools to identify the highest risk patients.

The pilot came about because “[w]e were concerned about managing chronic conditions, and recognized the difficulty in engaging people in diabetes or heart failure if they were depressed,” she explained. The pilot worked within a patient-centered medical home, which requires the documentation of quality for behavioral health. MGH built registries to track the progress of the patients over time, Edgman-Levitan said.

As part of the initiative, physicians had access to a phone number staffed by psychologists to answer questions. “We’ve never had a resource like that available every day; that’s something people are excited about.” Also, they developed education tools for clinicians, including specific information on depression to increase their overall knowledge.

“We think the pilot gave evidence that the coaches and psychiatrists are incredibly reassuring to the physicians,” she said.

Rhode Island is working to integrate behavioral health and primary care in another way: through better exchange of digital health information. The state’s health information exchange, CurrentCare, provides 78 unique data feeds, which include sensitive behavioral health information for those consumers who consent to it.

“It’s really, really important to have a comprehensive record,” said Laura Adams, executive director of CurrenCare, “We think this will lead us to a greater single source of truth. To be honest, we also think it’s going to be an excellent source of revenue.”

Engaging patients who otherwise couldn’t is a big part of bringing behavioral health awareness into primary care.

“Medicine at large is a people business in need of technology,” said Jordan Shlain, MD of HealthLoop. Failure of patients to engage should be viewed as a disease in need of treatment.

If a patient is not checking in for treatment, “we need physicians to be proactive,” he said. Also, systems need to be designed that are personalized with an empathetic narrative.

To treat patients more holistically, technology needs to extend from the world of healthcare practitioners and into the context of peoples’ daily lives and choices, said Philip Graves, a consumer behavioral expert.

Smartphones and natural language processing are potential tools, but apps must operate with an ongoing sense of reward to keep users engaged. “If you can have dialogue with something, you can naturally integrate it into your life.” Also, it must utilize personal support elements to have an impact, he said.

“The technology exists--what we are looking for now is the imagination of the healthcare market to recognize that opportunity and embrace it.”