Integrated Behavioral Health is threatened by the plight of hospitals

This week, KYW Newsradio in Philadelphia is presenting a special report, "Health Care Reform - Unfinished."  The report points out that while there are over 9 million less uninsured people in the US than before the Affordable Care Act was in place, hospitals are not immediately reaping benefits.  There is less uncompensated care needed, but there are reductions in payments to hospitals that are coming faster than the benefits of increased coverage.  All of the projections on which the ACA was based paint a picture of a better fit between health services capacity and people's needs because fewer patients will put off preventive care or early intervention for lack of being insured.  All of these projections are for a gradual increase of fit, while that cuts come immediately. 

Integrated behavioral health in primary care is an example of the best of the improved fit between patients' needs and adapted health services.  The connection has been made over and over between the impact of behavioral factors on morbidity, mortality and cost, and the improvement in all that can be achieved when targeted behavioral health services are embedded in primary care services.  For many of us in the business of developing the workforce for integrated primary care and consulting to support practice transformation, the future should look bright, even if our colleagues in some other ends of the health care continuum may be struggling. 

What is forgotten by a great many people is that primary care, and especially the practices that have been able to support the integration of behavioral health, do not exist in a vacuum.  A substantial percentage of practices that have advanced integration of behavioral health are part of health systems that are anchored by major medical centers.  The financial health of the dominant institution in a system has powerful effects on much smaller parts of the service array, no matter how forward looking those parts might be.  It will be important for all of us in the world of integrated care to be aware of and expressive about the importance of the health of the larger system, and of its successful transition to the future if we are to support the maintenance of integrated services for the newly insured patients who have hoped to benefit from the Affordable Care Act.

Alexander Blount