Behavioral Health Integration in Maternal Mental Health
What is Behavioral Health Integration?
Behavioral health integration (BHI) integrates mental health (MH) care into primary care provider settings, including obstetrics. The goal of BHI is to improve the health of the whole person and to do so as a part of routine care, leaving specialty mental psychiatric care to those with complex psychiatric conditions such as bipolar disorder. BHI practices fall on a continuum: as simple as depression screening and referral, to screening for the range of MH and substance use disorder (SUD) care and offering the full range of treatments through the PCP/obstetric provider clinic (including therapy, psychiatry, and addiction medication management).
BHI increases patient education about mental health, increases routine screening and diagnosis, reduces stigma, and improves early intervention and treatment. Early identification can reduce unnecessary suffering, disability, and loss of income and also reduce poor long-term outcomes like chronic or treatment-resistant depression.
Why BHI?
In the general population, behavioral health conditions are extremely common, affecting nearly one in five Americans.
Conditions such as depression can be very disruptive, occurring among younger as well as older Americans and leading to significant disability and lost income. Untreated depression and other mental health disorders cost the U.S. billions in lost productivity and comorbid health challenges. The same is true for maternal mental health disorders which also impact the developing infant.
BHI in Obstetric Clinics
The American College of Obstetricians and Gynecologists has long recommended that Ob/Gyns screen for MMH disorders and, in 2023, released comprehensive clinical practice guidelines for screening, diagnosis, and treatment. Despite these recommendations and the larger BHI movement, BHI has been elusive in primary and maternity care.
Scaling BHI
BHI hasn’t happened organically largely because mental health care is not included in PCP contracts with payors. On the contrary, mental health care is “carved out” of medical insurance coverage altogether and provided through separate behavioral health plans/carriers. See the Policy Center’s issue brief which addresses the need to “carve in” mental and behavioral health care into medical coverage and provider contracts.
The path forward must include payor-primary care provider contract revisions to require PCPs and OBs to screen and treat according to guidelines. Payors must also adequately reimburse for this critical care,shifting costs to early detection and intervention. We suggest reimbursing all PCPs and OBs on a fee-for-service basis with annual tiered rates based on performance monitored through claims data.
Related
BHI Billing and Reimbursement Guide
From the Commonwealth Fund, In Focus: Integrating Behavioral Health and Primary Care
From NIH: The impact of primary care behavioral health services on patient behaviors: A randomized controlled trial
https://pubmed.ncbi.nlm.nih.gov/32202830
From HHS: Roadmap for Behavioral Health Integration
https://aspe.hhs.gov/reports/hhs-roadmap-behavioral-health-integration