Integrated Primary Care:

The Central Piece in the Healthcare Puzzle

Illustration by Mona Caron

Integrated Primary Care combines medical and behavioral health services to more fully address the spectrum of problems that patients bring to primary medical care.  Because the vast majority of patients in primary care have either a physical ailment that is affected by stress, problems maintaining healthy lifestyles or a psychological disorder, it is clinically effective and cost effective to make behavioral health providers part of  primary medical care.  IPC allows patients to feel that for any problem they bring, they have come to the right place. By teaming mental health and medical providers, IPC is the structural realization of the biopsychosocial model advocated so broadly in Family Medicine and Psychiatry.  It is the reunification in practice of the mind and the body, for so long addressed in the separate worlds of medical and mental health treatment.  

This site describes what IPC is like in practice by linking with descriptions of existing programs.  It puts visitors in contact with books, journals, organizations, and web resources concerning Integrated Primary Care.  It offers evidence on the clinical effectiveness and the cost effectiveness of IPC.  There is a new page on funding IPC. There is special attention paid to integrating care for low income and underserved populations, children's behavioral health needs in primary care, and discussions of training programs for professionals.  There is a page for programs listed by state and country.  There is a new page on tool kits for practice.  Finally, there is a bibliography .  

Recent additions and new links of interest include (4/15/08):

New Certificate Program offered by the Department of Family Medicine and Community Health, University of Massachusetts Medical School, for mental health professionals who want to learn to work as primary care behavioral health providers. 

The best conference to learn about the latest in integrated care, clinically, administratively and financially is the annual conference of the Collaborative Family Healthcare Association, November 6-8, 2008, at the Hyatt Regency in Denver, CO.  (And start planning now for the 2009 conference in San Diego).  If you were an attendee of the 2007 conference or a member of CFHA, you have access to all of the presentations at the 2007 conference on the CFHA website.

Internships in Integrated Primary Care:  Can't promise that this is up to date.

North Carolina expands primary care program and saves millions.  Integrated care is central to the new approach.  Allen Dobson, MD, for Secretary of HHS! (Is that too political for the web?)

The HOGG Foundation in Texas gives a compelling justification for why it is putting its money into Integrated Care.

Resources for integrated care in Rural settings.

The Politics of Health and Behavior Codes:  The "health and behavior codes" (96150-96155) are billing codes that pay for behavioral health services for patients without a psychiatric diagnosis.  They can be used for services to support medical compliance, health behavior change, relaxation response therapies for many chronic illnesses, other behavioral health components of medical treatment for chronic illness such as group visits for diabetes.  Check the Indications for Coverage from the CMMS Website. In several states, the implementation of these codes have made integrated care financially viable in Federally Qualified Health Centers. Because they are medical and not mental health codes, they are treated as medical services and paid from the medical benefit.  Usually there is no need for pre-authorization or onerous multi-disciplinary sign-off.  Medicaid in each state is mandated to fund them in FQHCs by HRSA Program Information Notice.  Presently compliance is uneven.  Only in a few states (eg, Arizona) have health providers actively advocated for the state to comply with the PIN and therefore achieved a difference in reimbursement possibilities. Requirements for documentation. Advice on solving some billing problems with H-B codes.

There are now models based on well proven research protocols that are available on the web for other sites to use.  The IMPACT program for elderly patients with depression, and the STAR*D program are excellent examples.

Here is a brief fact sheet developed by the Association of State and Territorial Health Officers. This document provides some background data on the reasons for integration of mental health and primary care services as well as additional resources on this issue. 

The Air Force has committed to integrating behavioral health into all its health facilities.  They have published a Practice Manual for Behavioral Health in Primary Care, plus Appendixes 1 and 2.

Here are two papers on the economics and policy implications of integrating behavioral health into primary care.  One is part of the Health Care for the Whole Person initiative of the President of the American Psychological Association, Ronald Levant (now Past President).   It was written by Alexander Blount along with Michael Schoenbaum, Roger Kathol, Bruce Rollman, Marshall Thomas, William O'Donohue and C. J. Peek.  The other was prepared for the National Council for Community Behavioral Healthcare by Barbara Mauer.  She has asked that we "feel free to pass it on to anyone you think may find it useful."  You should also check out their website for lots of other useful info.

The US Preventive Services Task Force now recommends regular screening of adults in primary care for depression.

Health Care for the Homeless ( HCH ) Programs has a nationwide HCH Clinicians Network.  HCH programs , by design and necessity , have been integrating Primary Medical Care with Mental Health Care and Substance Abuse Services for more than 20 years.

Here is a paper called Integrated Primary Care: Organizing the Evidence by Alexander Blount in as it was published in Families, Systems & Health, V 21, 2003.  The paper categorizes integrated programs and shows what evidence there is for each sort of program.

The National Council for Community Behavioral HealthCare offers a site for Behavioral Health/Primary Care Integration Resources for Behavioral Healthcare Providers.

Integrating Primary Care and Behavioral Health Services: A Compass and a Horizon. These are the slides from a workshop for providers in FQCHCs provided by the Bureau of Primary Health Care prepared by Kirk Strosahl.

    And Others:

Report of a Surgeon General's Working Meeting On the Integration of Mental Health Services and Primary Health Care , issued 2001.

Or you can search for what interests you:

Want to contact other people interested in Integrated Care?  Use the Bulletin Board of the Collaborative Family Healthcare Association.

This page is maintained by Alexander Blount, Ed.D.  It is meant to reflect the evolving state of Integrated Primary Care nationally.