Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care

Abstract

Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.

Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care

“…Implementation of PBHCI in settings with lower starting points may achieve contrasting results. In addition, only two years of follow-up data were available for the wave 2 clinics, while previous have suggested that the impact of integrated programs may take additional time to occur (Krupski et al, 2016). …”

“…A study of two PBHCI programs in Washington State compared inpatient and outpatient utilization by patients enrolled in the program with that received by patients seen in the same clinic who did not enroll. Although the study found that PBHCI increased utilization of outpatient physical health services, data used in the study were limited to care received from providers who were affiliated with the PBHCI site (Krupski et al, 2016). More comprehensive data on utilization are needed to determine whether additional care was received from external providers or whether care previously received from external providers was simply shifted to the PBHCI clinic.…”

Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness

“…28,35,36 Krupski and colleagues found reduced all-cause hospitalizations in an established BHH program but not a newer one, and no BHH impact on ED use. 28 Evaluation of the Health Home demonstration in Missouri (while not solely a BHH intervention) showed reduced hospitalizations and ED use among enrollees. Service use reductions occurred after only one year, inclusive of a lengthy ramp-up period, and as Krupski et.…”

“…12,25,26 Yet the effectiveness of BHH models remains in question. Studies to date have applied the BHH in unique settings such as the Veteran’s Health Administration, 20,27 examined varied BHH intervention components, 23 included diagnostically heterogeneous populations, 23,28 or focused primarily on physical health outcomes. 28 Even evaluations that specified intervention components have yielded mixed findings, such as improvements in quality measures but not clinical outcomes.…”

“…Studies to date have applied the BHH in unique settings such as the Veteran’s Health Administration, 20,27 examined varied BHH intervention components, 23 included diagnostically heterogeneous populations, 23,28 or focused primarily on physical health outcomes. 28 Even evaluations that specified intervention components have yielded mixed findings, such as improvements in quality measures but not clinical outcomes. 29 Recent work comparing two integrated care approaches 30 identified that programs with greater integration were associated with improved self-reported health, increased screening for chronic conditions, and reduced hypertension, but increased rates of diabetes/prediabetes.…”