Rutgers study bolsters case for integrated behavioral health, primary care services

Research shows behavioral health conditions can complicate management of other health problems.

But Rutgers University professor Sujoy Chakravarty wanted to know just how much of a factor it is in thirteen low-income areas of New Jersey.

“Forty percent of preventable hospitalizations indicated a diagnosis of a behavioral health condition,” said Chakravarty. And those were just diagnoses made during a hospital visit, which Chakravarty said makes it a conservative estimate.

In this case, behavioral health combines people with mental health and substance abuse disorders.

Chakravarty’s team looked at a few high-cost groups of hospital users: people with chronic illness, and those who are considered “high users” (top 5 percent) of hospital services. According to payment data in the 13 communities studied, these groups contained larger than average numbers of people with a behavioral health diagnosis.

The study also broke out different types of hospital admittances by type of insurance. Across the board, Medicaid users in these two groups showed the highest rates of behavioral health issues.

This study adds to a growing body of research on how co-occurring health and mental health issues affect health care costs – and quality of care.

“What our study really underscores is … the importance of integrated care between physical and health services,” said Chakravarty.

Adding fuel to the integrated care fire

This type of information isn’t new. “Sometimes, it takes a really big pile of evidence to change people’s minds,” said Jeffrey Brenner, executive director of the Camden Coalition of Healthcare Providers.

He said regional information is important to continue “a 20-year trend” to reshape health care providing organizations, or what he called, “better care at a lower cost.”

Services like these are already under way. The federal government established an office called the Academy, dedicated to providing research and resources on integrating behavioral health into primary care, within the Agency for Healthcare Research and Quality.

Charlotte Mullican, the Academy’s senior adviser for mental health research, said “the research shows that integrating behavioral health and primary care is cost-effective.” But, she said, barriers to implementation exist: different payment structures, different types of providers, and changing patients’ perception of what type of care to ask for from a primary provider.

Policy changes are making some of those things easier. In New Jersey, changes to the Medicaid comprehensive waiver system are under way to make accessing behavioral care easier.

At the federal level, earlier this year the Department of Health and Human Services allotted $55 million to 221 community health centers in 47 states to add behavioral health care to their services.

In the region, federally qualified health centers are piloting their own in-house behavioral health services, and even supermarkets are getting joining in the one stop shop model.