Dr. Ed Wagner of the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle.

Behavioral health integration: What does it really mean in primary care?

By Dona Cutsogeorge, staff author and communications coordinator at the MacColl Center for Health Care Innovation at Group Health Research Institute

I recently sat down with Dr. Ed Wagner to chat about one area of work our team at the MacColl Center for Health Care Innovation is doing these days: integrating behavioral health care into primary care practices.

Q: What is behavioral health integration?

There is some confusion—maybe even disagreement—around what really constitutes behavioral health integration in primary care. If you ask the average primary care provider, “What would really help you?” they most often would answer, “I need someone who can help manage crises, help the distressed patient, and be available if there is a crisis.” The average provider most wants help throughout the practice day addressing difficult psychiatric-social issues that often arise in primary care visits.

It’s a useful first step to add behavioral health specialists to practice teams. But what we’ve learned in the work that we’ve done and in reading about the work that others have done is that just because you’ve added a behavioral health specialist to your team, it doesn’t mean you have an integrated behavioral health program.

Integration of care becomes critical as the complexity of peoples’ illnesses increases. There’s emphasis at the federal level and through all of the recommendations that we’ve seen to really integrate and not just co-locate.

Q: What’s the difference between co-location and integration?

Co-location is often what happens. This is when a primary care practice has a behavioral health specialist on staff who’s got an office space, clientele, and his or her own schedule—but there’s little interaction, and there’s little sharing of care. Co-location doesn’t necessarily mean that services are really well integrated.

Integration occurs when the behavioral health specialist is an active member of the primary care team. An integrated care team has primary care providers working together with behavioral health specialists in planning care for patients with behavioral health issues.

Q: What type of behavioral health provider works on a primary care team?

Ideally, from my point of view, the best behavioral integration would have someone on site—generally a therapist (LCSW) who can handle the crises and some of the diagnostic issues. To help with psychotropic medications, a psychiatric consultant is also needed. This provider agrees to work with the practice, often virtually so that the patients don’t need to go to another clinic. This consultant primarily interacts with the provider, helping to create an optimal medication regime. He or she is also available if a patient needs more complex treatment.

You need all of those resources to really manage the variety of behavioral health issues that a primary care practice sees. The good practices have this: They all have a co-located, integrated behavioral health specialist combined with agreements with consultants out in the community for medication and psychotherapy.

Learn more and access practical tools and resources that Dr. Wagner recommends to help your practice get started with behavioral health integration.

Ed Wagner, MD, MPH, is Director (Emeritus) of the MacColl Center for Health Care Innovation and a Senior Investigator at Group Health Research Institute. He and his team developed and disseminated the Chronic Care Model, an evidence-based framework for health care that delivers safe, effective, and collaborative care to patients. Dr. Wagner serves on the editorial boards of Health Services Research, the British Medical Journal, and the Journal of Cancer Survivorship. He is a professor of health services at the University of Washington School of Public Health and an elected member of the Institute of Medicine.

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