How about going even further, and introducing the
concept of a Behavioral Health Medical
Home (BHMH)? Does this mean that a
patient who experiences chronic mental illness that lacks primary care services
or vice versa could get whatever he or she needs all in one place, you
ask? Why yes…I believe it does! And it’s already being done at Cherokee
Health System (CHS) in Tennessee. ( http://www.cherokeehealth.com/)
I’m completely
impressed by CHS's integrated behavioral health program – what a practical solution to managing a complex
patient population. CHS recognized early
on that the needs of those with Severe Mental Illness (SMI) are very unique,
and exacerbated by the fact that (especially for Medicaid patients) there is
lack of social supports necessary to managing their conditions. The case for a behavioral health medical home
that integrates primary care is strong:
- Research has shown more mental health interventions occur
in primary care than in specialty mental health settings
- Over one-third of patients in most primary practices have
a psychiatric disorder
- PCP's often feel inadequate in addressing the behavioral health needs of their patients
- Treating mental health in the primary care setting may allow patients to overcome the stigma associated with receiving behavioral healthcare
- 80% of people with mental illnesses have 3+ chronic
conditions
- Those with SMI have high rates of diabetes, hypertension, obesity, and hyperlipidemia (this is often a side-effect of newer antipsychotic drugs)
Typical Service Scenario: The
PCP determines that psychosocial factors underlie the patient’s presenting
complaints or are adversely impacting response to treatment. During the visit, the PCP “hands off” the
patient to the BHC for consultation services (e.g., suicide risk assessment,
anxiety and anger management, substance abuse intervention)
Insurers such as BCBS of Tennessee are already taking notice of some very
positive results, that include reduced ER utilization, lower costs per patient,
and fewer hospital admissions. In
addition, CHS has identified an unconventional revenue stream by offering BHMH
integrated care training to other providers.
In short, the industry has taken note of the BHMH’s success.
“TN has a provider champion – Cherokee Health Systems – that is a
nationally recognized model for primary and behavioral health integration” – National Academy for State Health Policy
State Medicaid programs take note: The National Alliance on Mental
Illness has stated that Medicaid comprises over 50% of overall public mental
health spending (link). With States making moves to tighten budgets,
they should focus on programs that can do more with less – why not start with a
BHMH?
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