Integrating behavioral and primary care can improve care quality, study finds

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When adults received primary care from an integrated team of mental health and primary care clinicians, as opposed to traditional practice management practices, they experienced higher-quality care, according to a study in JAMA. Use of integrated care teams was also linked to lower care utilization.

Researchers from Intermountain Healthcare in Salt Lake City studied the effect of integrating behavioral health and primary care on patient outcomes and costs. The study included data from 113,452 adults who received primary care at 113 Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and also had yearly encounters with Intermountain through 2013.

When compared to patients who received care in a more traditional practice, patients who received care from an integrated practice had higher rates of active depression screening (46 percent versus 24 percent), adherence to a diabetes care bundle (25 percent versus 20 percent) and documentation of self-care plans (48 percent versus 8.7 percent).

Additionally, the group of patients who received integrated care saw fewer emergency department visits, hospital admissions, ambulatory care sensitive visits and primary care physician encounters.

In an editorial also published in JAMA, Thomas Schwenk, MD, from the University of Nevada, Reno, noted the importance of the Intermountain study.

"This study has several important implications," he wrote. "Integrated [team-based care] is clearly superior to [traditional practice management] for patients with complex mental illness and chronic medical disease."

However, Dr. Schwenk recognized that investing in this kind of care can be difficult for providers still in a fee-for-service world. Findings from the study illustrate Dr. Schwenk's concerns. Although quality improved, payments received by the delivery system were lower in the integrated group — $3,401 compared to $3,516.

"Practicing in an integrated, value- and outcomes-based model but continuing to be reimbursed in a traditional, volume-based system is costly," he wrote. "The investigators note that the investment cost of the program was lower than the reduction in reimbursement, but both are, in fact, a reduction in the bottom line for practices large and small, and therein lies the most important implication of this study."

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