Physician practices face challenges adopting behavioral health integration

While one in five adults has a clinically significant mental or substance use disorder, behavioral health integration into U.S. physician practices is still uncommon. Findings from a qualitative study published in Annals of Internal Medicine shed light on what physicians say are the barriers to adoption.

Stigma and behavioral health workforce shortages result in a substantial mismatch between the prevalence of mental health disorders and the proportion of persons who receive effective treatment. One potential solution is integrating behavioral health into medical care. As such, determining barriers to adoption is critical.

Researchers from Rand Corporation conducted semi-structured interviews with a diverse group of 47 physician practice leaders and clinicians, 20 experts, and five vendors at 30 physician practices to describe factors influencing physician practices' implementation of behavioral health integration. The yielded important insights about the motivations and barriers to integration. Practices were motivated to integrate behavioral health care to better meet the needs of their patients, as well as to enhance the reputation of their practice. Their approach to integration was tailored to their local resources, financial incentives, and patient populations. Barriers to integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Payment for service was an issue related to integration, as few saw a positive financial return on investment.

In an accompanying editorial, Sue Bornstein, MD of Texas Medical Home Initiative says that the value that primary care and cognitive services bring to the U.S. health care system is underappreciated. She suggests that fundamental changes must occur in payment and delivery systems in order for primary care to reach its full potential for achieving better health for persons and populations. The current pandemic has exposed the fragile state of primary care and underscores the need to strengthen the foundations of our system.