Primary Care: A Gateway
to Mental Health Care
Integrating mental and physical health care is perhaps the most effective solution to increase access to mental health treatment for most people, improve diagnostic rates and treatment success, and lower the cost of patients with physical and mental health disorders. Primary care is the most common entry point for those seeking health care. It is becoming a focal point of health care reform efforts as the “quarterback” of care, with growing responsibilities for managing the health of individuals and their families over time.
Return on every dollar spent for collaborative primary care.1
$23.95
Savings per member from integrating psychologist into primary care practice.2
$23.95
Today, primary care providers do end up providing the majority of mental health care — more patients seek mental health care in primary care than in any other health system setting, and primary care providers prescribe more mental health medications than any other provider type.
Financing
The way we pay for mental health care, addiction services, and primary care reinforces their siloed nature. We need financial models that better support mental health and addiction treatment onsite in primary care. This requires a move away from volume-based payment methods, focused on fees for services, to value-based payment methods that are more flexible, outcomes-based, and support integrated teams.
- The federal government should require that all primary care payment models initiated by CMS or by the states through waivers include consideration of whether the model would equip the affected practices with the resources they need to effectively offer integrated mental health care. This should include auditing and revising existing models as well as initiating new ones as appropriate and may include carving certain mental health services out of the cost benchmark to ensure that there are adequate incentives for building out integrated care.
- The federal government should mandate payers and providers to assess outcomes across population subgroups in an effort to ensure integration is promoting positive outcomes across all populations. If not, the federal government should support changes that will provide the culturally appropriate integrated care needed to help eliminate disparities.
- The federal government should mandate prioritization of mental health screening and outcome measures in federal value-based payment models – including ensuring that the measures are weighted to reflect their importance for population health. The federal government should also create a fund that can help low-performing systems improve by implementing evidence-based integration approaches.
- The federal government should create a seed fund that supports primary care providers, and especially Federally-Qualified Health Centers and Rural Health Centers, in developing the necessary capacity to begin seeking sustainable reimbursement for integrated mental health care services (which could be effectively paired with parity initiatives, as described later in this report).
- The federal government should make available planning grants and state learning collaboratives to design and implement effective Medicaid waivers and state plan amendments that meaningfully expand access to high-quality mental health care.
Training
Every year, thousands of new primary care providers enter the field – and most won’t have had training on integrated care. Of those already in practice, few receive any support in learning new skills and practice models for integrated care. Mental health care is not so different from the countless other health conditions primary care providers confront, but without training, effectively addressing it becomes an unreasonable expectation. Structured training opportunities for those both pre-service and in-service is critical for making mental health a standard part of primary care.
- The federal government should provide incentives, through Graduate Medical Education (GME), Graduate Nursing Education (GNE), and other programs, for health care practitioner education institutions to offer training in integrated mental health care.
- Providers should be incentivized to take additional Continuing Medical Education (CME) classes on current best practices.1
- The federal government should focus existing federally funded quality improvement organizations on mental health integration across diverse primary care practices and for serving diverse populations, and finance additional learning collaboratives as necessary.