The Financial Dimension of Integrated Behavioral/Primary Care

Abstract

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.Keywords Healthcare economics Á Medical cost offset Á Integrated behavioral/primary care Very few people do anything creative after the age of 35. The reason is that very few people do anything creative before the age of 35.

A Summary Report of the Cost-Effectiveness of the Profession and Practice of Marriage and Family Therapy

“…This is especially troubling given that public and private discourse about the current health care market is dominated by cost considerations (Christenson and Crane 2004;Cummings et al 2009). Similar to medical offset research (Law et al 2003), family therapy as a treatment procedure (and MFTs as a discipline) has not yet fully realized the importance of demonstrating cost-effectiveness and how related findings may benefit market share.…”

“…Similar to medical offset research (Law et al 2003), family therapy as a treatment procedure (and MFTs as a discipline) has not yet fully realized the importance of demonstrating cost-effectiveness and how related findings may benefit market share. Cummings et al (2009) (approaching the issue from the perspective of psychologists) argue that psychologists' unwillingness to address costs has led to ''a precipitous decline in their practices and in their incomes'' (p. 32). Individual psychotherapy practitioners have awoken to this reality and have pushed to improve conditions for reimbursement (e.g., Kessler 2008).…”

Inter professional teamwork: A case study examining the practice patterns and perceptions of pediatric psychologists

“…In addition, when all patients meet with the mental health provider, even briefly, stigma can be reduced. Previous research suggests routine access to a psychologist is a critical component of integrated care [24], potentially aiding in decreasing stigma associated with mental health services, acceptance of services, and meeting the needs of underserved populations [25,26]. Psychologists also noted that flexibility in clinic flow allowed for greater efficiency in patient care.…”

“…These non-billable roles have been identified as essential to being fully integrated into a comprehensive care team [27]. Demonstration of the cost effectiveness of IPT models that make some allowance for unbilled services while optimizing reimbursement of billed care will be imperative for sustained fiscal stability of IPT models [25].…”

Recovery-oriented Medical Training: An Informational Rapid Literature Review for the University of Recovery as a New Concept of Co-learning between Patients and (Future) Healthcare Providers

“…This relation has been intuitively known for centuries, but unfortunately, modern mental healthcare and physical healthcare are still often working in silos, if not one against the other [25], and with very important, if not tragic consequences in terms of poorer quality of life and shortened lifespan.…”