A year ago, the Colorado Health Institute (CHI) – the nonpartisan health research and data analysis organization – launched an innovative program designed to discuss key health care access issues.
These conversations are part of a series of “learning laboratories” put on in conjunction with CHI’s Safety Net Advisory Committee (SNAC). These “SNAC Labs” have included experts from The Colorado Trust, ClinicNET, the Colorado Community Health Network, the Colorado Health Foundation and many of the safety net clinics in the Denver-metro area.
The May 2014 Access to Care meeting focused on approaches to integrate behavioral health within the entire scope of care.
The reason for this topic? Mental health, substance abuse, life stressors, and yes, lifestyle behaviors, all contribute to one’s overall health. The data confirm that by controlling or resolving behavioral health issues we save health care costs and improve patients’ overall health. One example that shows how powerful behavioral health is was presented at the SNAC Lab: Depression is a top driver of overall health costs because it includes medical and pharmacy costs, both for treating depression and for medical conditions that often become worse when co-occurring with depression, as well as reduced work-related productivity.
How do we help people get the care they need?
About 50 percent of all behavioral health disorders that are treated are treated in primary care. In many cases, patients have nowhere else to go. In fact, two-thirds of physicians report they have no access to outpatient behavioral health care for their patients. In those cases where treatment is available, primary care physicians are referring patients to outpatient behavioral health centers, yet up to half of those patients never make their first appointment for care.
A solution is to integrate behavioral health with primary care, however this can put further responsibly on Colorado’s already stretched primary care workforce.
Several safety net organizations in Colorado are integrating care.
Three examples are Salud Family Health Centers, Axis Health Systems and Jefferson Center for Mental Health in partnership with Metro Community Provider Network. Early findings in this work are both positive and concerning, and the SNAC Lab discussion made it clear that providers are still learning how to implement efforts to integrate behavioral and primary care.
Safety net clinics are pioneering new models of care and identifying some of the best solutions for treating chronic illness. Still, there was considerable discussion about how primary care offices of different sizes can implement integrated care. On the one hand, it is helpful if they are large enough and have adequate staff to manage the added dynamics of patients’ needs – a challenge in under-served rural and low-income urban communities. It can be tougher for smaller practices. Many are working to create partnerships with other kinds of providers – primary care practices working with behavioral health practices – to help patients access a range of services in a more integrated way.
On the troubling side: Many clinics implementing integrated behavioral and medical care are doing so on limited dollars, often grants, which means there is no guarantee these programs will continue if financial resources are tightened.
Our takeaway from the SNAC Lab presentation? Primary care providers are needed more than ever, and the definition of primary care is expanding. Many primary care clinicians are working with diverse teams of providers to truly innovate and focus on not just treating one illness or another, but on systematically reforming the way we care for Coloradans.
We all need to value, encourage and support the hardworking health care providers that tirelessly meet the growing demand for health care services across the state. From those who work in large, urban hospitals to those who run a small practice in a rural community, doctors and their staffs are the lifeblood of every Colorado community.