TRENDS
Physical Health / Behavioral Health Primary care doctors draw the connection, but can they address it in their practices? Mind or body. Traditionally, if primary care physicians had to focus on one or the other when diagnosing and
treating a patient, they’d go for “body.” But that may be changing. In 2020, the American Medical Association and seven other physician organizations, including the American Academy of Pediatrics, American College of Obstetrics and Gynecology, and the American Academy of Family Physicians – joined forces to form the Behavioral Health Integration (BHI) Collaborative. Its mission is to enable physicians to sustain a “holistic and equitable approach to physical and behavioral healthcare in their practices.”
The need to gather and act on “biopsychosocial” data has been recognized in the medical community for years. In 1996, for example, an Institute of Medicine report on primary care cautioned that mental health and primary care are inseparable, and that avoiding one or the other usually leads to inferior care. And in 2011, the Robert Wood Johnson Foundation noted that “having a mental disorder is a risk factor for developing a chronic condition, and having a chronic condition is a risk factor for developing a mental disorder. When mental and medical 28
April 2021
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conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased healthcare costs.” As many as 40% of all patients seen in primary care settings have a mental illness, and given that mental and physical health problems are often interwoven, as many as 70% of primary care visits stem from psychosocial issues, concludes the National Center of Excellence for Integrated Health Solutions. While patients may initially present with a physical health complaint, data suggests that underlying behavioral health issues often trigger these visits. And in a study in the June 2020 issue of the Annals of Internal Medicine, researchers said that 68% of persons with a mental health problem also have medical conditions, and persons with chronic illness are twice as likely to have mental illness. Despite all these statistics, integrating behavioral and physical health is still uncommon among U.S. physician practices, the researchers said. And the reasons are no surprise. “Philosophically, behavioral health integration is not meant to succeed in fee-for-service,” noted one primary care practice leader cited in the study. “The traditional [financial accounting] measures don’t apply.” For four years, the Centers for Medicare & Medicaid Services has made separate payments to physicians and non-physician practitioners for BHI services. As of
